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Selected Publication:
Stoeckler, M.
Comparison of Ponseti versus Pantalar Release Treatment for Idiopathic Clubfeet – from Birth to Adulthood
Humanmedizin; [ Diplomarbeit ] Medizinische Universität Graz; 2022. pp. 91
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- Authors Med Uni Graz:
- Advisor:
- Kraus Tanja
- Svehlik Martin
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- Abstract:
- Introduction: The clubfoot, also referred to as congenital talipes equinovarus (CTEV), is one of the most common musculoskeletal deformities and the most common foot deformity at birth, with incidences between 0.6 to 2.57 per 1000 live births. Previous studies by Zwick et al. and Švehlik et al. have shown that conservative treatment (Ponseti method), including a combination of gentle manual manipulation and "toe-to-groin” plaster cast of idiopathic clubfoot is superior to surgical treatment (pantalar release). However, a prospective randomised long-term comparison is still missing. Therefore, the aim of this follow-up study was to compare the longterm-outcome of two treatment methods (Ponseti and pantalar release) in terms of mobility and function of the ankle joint. Furthermore the morphological and radiological results, as well as the individual improvement in quality of life, were evaluated. Material and Methods: The design of this trial is a long-term, previously randomised, non-blinded, prospective single-centre study. Nine patients of the Ponseti group (n=12 feet) and five patients of the surgical group (n=9 feet) from the previous studies were invited to a third follow-up 17-19 years after the initial treatment. In addition to a clinical examination, the Functional Rating System (FRS), the International Clubfoot Study Group (ICFSG) protocol, the Adolescent Outcomes Questionnaire (PODCI), Short-Form-36 (SF-36) questionnaire and the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot and midfoot Scales were used to compare the two groups in terms of foot function, morphology, quality of life and radiological outcomes. Furthermore, a 3D gait analysis and a handheld dynamometry (HHD) were performed to evaluate the kinematic and kinetic data of the foot. Results: Significant differences in dorsiflexion (p=0.043), FRS (p=0.0001) and ICFSG protocol (p=0.001) were found in favour of the Ponseti group. Moreover, the Ponseti group also performed statistically significantly better in the AOFAS ankle hindfoot (p=0.0003) and midfoot (p=0.001) scale. In the 3D gait analysis, differences were found in ankle power (p=0.002) and range of motion (p=0.004) as well as in kinetic parameters (p=0.005). The PODCI and SF-36 results highlight the more frequent and more severe occurrence of pain in the surgical group. Discussion: Our study was able to show the superiority of the Ponseti method in terms of functionality, freedom from pain and ankle mobility as well as kinetic properties compared to the surgical group in a long-term comparison (mean follow-up time: 18 years).