Inferior results with unilateral compared with bilateral brace in Ponseti-treated clubfeet

• Published in: Journal of children's orthopaedics Vol. 11; no. 3; pp. 216 - 222
• Main Authors: Sætersdal, C., Fevang, J. M., Engesæter, L. B.
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.06.2017; The British Editorial Society of Bone and Joint Surgery
• Subjects: Original Clinical; bilateral brace; Ponseti; unilateral brace; Clubfoot
• ISSN: 1863-2521; 1863-2548
• DOI: 10.1302/1863-2548.11.160279

Purpose The Ponseti method for treating clubfoot was introduced in Norway in 2003, and a cohort of children has been followed for 8 to 11 years. In a previous study, we found good results after follow-up of two to five years, with 3% rate of extensive surgery (posterior release or posteromedial release). During 8 to 11 years of follow-up, the rate of extensive surgery increased to 11%. The children had been treated with a bilateral brace or a unilateral brace. In this multicentre study we aimed to compare these two post-corrective treatment methods. Methods In all, 94 children (133 feet) were initially treated according to the Ponseti method, and had post-corrective treatment with either a bilateral foot abduction brace or a unilateral above-the-knee brace. The children were examined at a mean age of 9.3 years (8 to 11) regarding flexibility and deformity of the foot and ankle. Information including type of brace, brace compliance and surgical procedures was ­obtained from the patient records. The parents answered questionnaires and radiographs were taken of the feet. Results Feet treated with a bilateral brace had better dorsal flexion (p = 0.008), plantar flexion (p = 0.02), external rotation (p = 0.001) and less forefoot adduction (p = 0.04) than feet treated with a unilateral brace. Children using a bilateral brace had a better Functional Rating System score (p = 0.005) and Disease Specific Instrument score (p = 0.02). Conclusion Children treated with a bilateral brace had better parent-reported outcomes and more flexible feet than children treated with a unilateral brace. Our results do not support the use of a unilateral foot abduction brace in clubfoot treatment.