Idiopathic congenital clubfoot: Initial treatment. 2013

F Bergerault, and J Fournier, and C Bonnard
Pediatric Orthopedics Department, Clocheville Hospital, Tours University Hospital, Tours, France. f.bergerault@chu-tours.fr

Clubfoot (talipes equinovarus) is a three-dimensional deformity of unknown etiology. Treatment aims at correction to obtain a functional, plantigrade pain-free foot. The "French" functional method involves specialized physiotherapists. Daily manipulation is associated to immobilization by adhesive bandages and pads. There are basically three approaches: the Saint-Vincent-de-Paul, the Robert-Debré and the Montpellier method. In the Ponseti method, on the other hand, the reduction phase using weekly casts usually ends with percutaneous tenotomy of the Achilles tendon to correct the equinus. Twenty-four hour then nighttime splinting in abduction is then maintained for a period of 3 to 4 years. Recurrence, mainly due to non-compliance with splinting, is usually managed by cast and/or anterior tibialis transfer. The good long-term results, with tolerance of some anatomical imperfections, in contrast with the poor results of extensive surgical release, have led to a change in clubfoot management, in favor of such minimally invasive attitudes. The functional and the Ponseti methods reported similar medium term results, but on scores that were not strictly comparable. A comparative clinical and 3D gait analysis with short follow-up found no real benefit with the increasingly frequent association of Achilles lengthening to the functional method (95% to 100% initial correction). Some authors actually suggest combining the functional and Ponseti techniques. The Ponseti method seems to have a slight advantage in severe clubfoot; if it is not properly performed, however, the risk of failure or recurrence may be greater. "Health economics" may prove decisive in the choice of therapy after cost-benefit study of each of these treatments.

UI MeSH Term Description Entries
D007223 Infant A child between 1 and 23 months of age. Infants
D002648 Child A person 6 to 12 years of age. An individual 2 to 5 years old is CHILD, PRESCHOOL. Children
D002675 Child, Preschool A child between the ages of 2 and 5. Children, Preschool,Preschool Child,Preschool Children
D003025 Clubfoot A deformed foot in which the foot is plantarflexed, inverted, and adducted. Equinovarus,Talipes Equinovarus,Clubfeet,Clubfeet, Congenital,Clubfoot, Congenital,Congenital Talipes Equinovarus,Pie Torcido,Congenital Clubfeet,Congenital Clubfoot,Pie Torcidos,Talipes Equinovarus, Congenital
D003663 Decision Trees A graphic device used in decision analysis, series of decision options are represented as branches (hierarchical). Decision Tree,Tree, Decision,Trees, Decision
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man

Related Publications

F Bergerault, and J Fournier, and C Bonnard
December 2016, Orthopaedics & traumatology, surgery & research : OTSR,
F Bergerault, and J Fournier, and C Bonnard
January 1977, Clinical orthopaedics and related research,
F Bergerault, and J Fournier, and C Bonnard
January 1999, Orthopedic nursing,
F Bergerault, and J Fournier, and C Bonnard
January 1999, Orthopedic nursing,
F Bergerault, and J Fournier, and C Bonnard
February 2022, Pediatrics,
F Bergerault, and J Fournier, and C Bonnard
March 1995, AORN journal,
F Bergerault, and J Fournier, and C Bonnard
January 1991, Orthopedic nursing,
F Bergerault, and J Fournier, and C Bonnard
October 1948, Belgisch tijdschrift voor geneeskunde,
F Bergerault, and J Fournier, and C Bonnard
January 1997, Clinics in podiatric medicine and surgery,
F Bergerault, and J Fournier, and C Bonnard
January 1996, Zeitschrift fur Orthopadie und ihre Grenzgebiete,
Copied contents to your clipboard!