Article

The initial treatment of congenital idiopathic clubfoot (CIC) is
nonoperative. Either the French physiotherapy method or the Ponseti casting
method may be used. Whether either method is superior over the other remains
unclear. However, the method used initially is not the only determinant of the
final outcome. The primary objective was to identify determinants of
the final outcome as evaluated based on the need for surgical treatment and on
the Ghanem-Seringe score. HYPOTHESIS: Factors associated with the final outcome
can be identified. METHODS: Between 2004 and 2011, 100 CICs in 79 patients were
treated in two centres, 47 using the French method and 53 the Ponseti method. The
Dimeglio grade was determined at baseline and the Ghanem-Seringe score at last
follow-up. Surgical procedures (if any), splinting duration, and rehabilitation
therapy duration were recorded. The two groups showed no statistically
significant differences for Dimeglio grade distribution, time from birth to
treatment initiation, or mean follow-up. RESULTS: Factors significantly
associated with a poor outcome by univariate analysis were use of the Ponseti
method (P=0.0027), older age at last follow-up (P=3x10-4), initial Dimeglio grade
(P=7x10-5), and need for surgery (P=10-5); no significant effect was found for
splinting duration, rehabilitation duration, bilateral involvement, or antenatal
diagnosis. By multivariate analysis, factors independently associated with a poor
prognosis were older age at last follow-up, Dimeglio grade, and need for surgery.
CONCLUSION: This study confirms the major prognostic significance of initial
severity (Dimeglio grade) on the final outcome. The data do not firmly establish
that one method is superior over the other. Nevertheless, the need for percutaneous Achilles tenotomy with the Ponseti method leads us to prefer the
French physiotherapy method. LEVEL OF EVIDENCE:
IV, retrospective study.
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Langue : FRANCAIS