Degree of hyperabduction 45° vs. 70°

December 8, 2005

I recently sent this abstract off-line to one of the members here,

so since it was ready to paste, I thought I'd re-post it in case

some of you haven't seen it- it's available on the Ponseti_links

site as well. This is the abstract for the study that Dr. Morcuende

recently presented on comparing the results in Dr. Ponseti's early

patients who were abducted to 45° to the more recent patients after

the 70° angle was established.

Clubfoot Relapses: Natural History and the Effects of foot

hyperabduction

Lovell, BS, Lori Dolan Ph.D, Ignacio Ponseti, M.D.,

A Morcuende M.D., Ph.D

University of Iowa

Iowa City, Iowa, U.S.A.

Background: Clubfoot can be effectively treated with the Ponseti

method, but relapses are common if not braced. This study evaluates

the long-term natural history of relapses and the effect of foot

hyperabduction.

Methods: Consecutive case-series from 1948 through December 2000. A

total of 320 patients (502 clubfeet) were evaluated. None of the

patients had previous foot surgery except tendoachilles tenotomy

(7%). Two groups were analyzed based on hyperabduction in last cast

and brace: Group I: not maximum abduction (n=291). Group II: with

maximum abduction (n= 211).

Results: 70% of patients were male, 57% had bilateral deformity, and

51% had left side involvement. Clubfoot correction was obtained in

286/291 (98%) of group I and 209/211 (99%) of group II. In group I,

170 (58%) had a relapse compared to 59 (28%) in group II (p<0.0001).

91% of relapses occur before the age of five years, but relapses may

occur up to eleven years of age. Noncompliance with the brace was

similar in both groups (65% vs 61% ) and relapses were related to

non-compliance (p=0.001). Surgical releases decreased from 11% in

group I to 4% in group II (p=0.004), and anterior tibialis transfer

from 51% in group I to 15% in group II (p<0.0001).

Conclusion: By 5 years of age less than 10% of feet will relapse,

but the tendency to may persist until 11 years of age. Maximum

abduction of the last cast and brace have significantly reduced

relapses and the need for extensive corrective surgery.

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