Article

There is no consensus on how to predict residual
equinovarus deformities after application of the Ponseti method. We assessed the
prognostic value of clinical scoring systems, and also radiographic parameters
that can be measured just before percutaneous Achilles tenotomy (PAT). METHOD: We
reviewed 50 cases of clubfoot in 35 patients who were treated using the Ponseti
method, including PAT, to analyze the factors that are predictive of residual
equinovarus deformities. Mean age at the time of PAT was 2.4 (1.4-3.5) months,
and the mean follow-up period was 23 (9-61) months. We divided these cases into 2
groups according to the need for further surgery to treat the residual
deformities. RESULTS: 40 feet with satisfactory results were included in group 1,
whereas the remaining 10 feet that required further surgery for unsatisfactory
residual deformities were included in group 2. We compared the initial Dimeglio
and Pirani scores obtained before the first Ponseti casting, follow-up Pirani
scores, and radiographic parameters determined just before PAT between these 2
groups. There was no statistically significant difference between the groups in
terms of the initial Dimeglio and Pirani scores, although the follow-up Pirani
scores and lateral tibiocalcaneal angle were higher and the lateral talocalcaneal
angle was lower in group 2 at the time of PAT. INTERPRETATION: We conclude that
the Pirani score, lateral tibiocalcaneal angle, and talocalcaneal angle, when
assessed immediately before PAT, might be predictive factors for residual equinovarus deformity following Ponseti treatment for severe idiopathic clubfoot.

Langue : ANGLAIS