Treatment of Idiopathic Congenital Clubfoot in a Public Health Service: Comparison Between Ankle-Foot Orthosis and Abduction Orthosis.

BACKGROUND

To evaluate the efficacy of the Ponseti method in the treatment of idiopathic congenital clubfoot (CCF) in a public health service, during 2 distinct periods, focusing on the impact of orthosis type (ankle-foot orthosis and abduction orthosis).

METHODS

This retrospective longitudinal cohort study analyzed medical records of 552 patients (842 feet) with CCF treated with the Ponseti method at a single hospital. Individuals were categorized into 2 groups: group 1 (2009 to 2017), which used an ankle-foot orthosis (AFO) after casts; and group 2 (2017 to 2021), which used an abduction orthosis (AO). Outcomes evaluated included relapse rates, residual deformities, and functional results using the modified Laaveg-Ponseti scale. The χ 2 tests and Student and Welch t tests were used to assess statistical significance.

RESULTS

The mean follow-up period was 10.3 years for group 1 and 5.3 years for group 2. Significant differences were observed between the groups ( P <0.05). Group 1 (AFO) showed higher rates of relapse (71.9% vs. 31.2%) and residual deformities (58.8% vs. 32.6%) compared with group 2 (AO). Functional outcomes were also superior in group 2, with 81.8% achieving good/excellent results on the modified Laaveg-Ponseti scale, compared with 69.3% in group 1. Family adherence was lower in group 2 (16.5% nonadherence) compared with group 1 (10.5% nonadherence) and was related to higher relapse, yet overall outcomes were better.

CONCLUSION

The Ponseti method is effective for treating CCF, with superior results when an abduction orthosis is used. This highlights the importance of appropriate orthosis selection and continuous family support in public health services.

LEVEL OF EVIDENCE: Level III-retrospective comparative study.