Effect of cast removal timing in the correction of idiopathic clubfoot by the Ponseti method.

Clubfoot correction by the Ponseti method is highly successful with an average of 5 casts in the majority of patients. However, early experience with the technique demonstrated that many cases required more than 5 casts for correction. The purpose of this study was to evaluate the effects of timing of cast removal before subsequent manipulation and casting in the correction of club-foot using the Ponseti method. We reviewed 90 patients (129 clubfeet) treated between December 2000 and June 2006. Two groups were evaluated. Group A: 44 patients (63 clubfeet) had their cast removed by the parents the night before the visit. Group B: 46 patients (66 feet) had their cast removed in the clinic just before the new casts were applied. Overall, full correction was obtained in 128 (99%) clubfeet, with only 1 clubfoot requiring surgical release. Group A required an average of 10 casts (range: 4 to 22), compared to 5 casts (range: 4 to 10) in Group B (p = 0.001). Average time for correction was 13 weeks in Group A and 6 weeks in Group B (p = 0.001). There were 20 relapses (22%), 12 (27%) in Group A and 8 (17%) in Group B (p = 0.42). In conclusion, removing the cast just before the new cast is applied significantly decreases the number of casts required for correction and shortens the length of treatment.