Where can I find more info on the French Method?

[Guest guest]

Is this method widely practiced? Is it more prominent in Europe than

in the states?

jenny

[Guest guest]

Here is an abstract I just found:

NONOPERATIVE CLUBFOOT TREATMENT USING PHYSICAL THERAPY

B. s s III, MD

Holly , PT – Dallas, TX

Objective:

Determine success rate of the French physical therapy program in patients with

idiopathic clubfeet.

Methods:

Eighty-four patients with 125 idiopathic clubfeet were evaluated. All were 3

months old or

less when treatment was begun. Massage of the clubfoot followed by taping was

performed five days per week by experienced physical therapists for up to 12

weeks,

with intermittent visits with the physical therapist over the next 12-18

months. Each foot

was graded for severity using Dimeglio's classification prior to treatment

(moderate,

severe, very severe). Eighty-three of the 125 feet did not have access to

adjunctive

continuous passive motion (CPM). Outcomes were classified as excellent

(plantigrade

foot without surgery), fair (percutaneous heel cord release or limited

posterior release),

or poor (posteromedial release).

Results:

Followup averaged 31 months (range 20-42). Moderate feet had 20 excellent, 6

fair, and

3 poor outcomes. Severe feet had 40 excellent, 21 fair, and 17 poor outcomes.

Very

severe feet had 1 excellent, 8 fair, and 9 poor outcomes. Overall, 49% of

patients' feet

achieved excellent outcomes and 28% fair outcomes. Twenty-three percent

required

posteromedial releases to achieve a satisfactory plantigrade position. If CPM

was not

utilized, there was slightly higher percentage of feet requiring posteromedial

release

(CPM:17%, No CPM:27%).

Conclusion:

Half of the idiopathic clubfeet in patients 3 months old or less treated by

experienced

physical therapists achieve a satisfactory plantigrade position without the

need for any

surgical intervention, including percutaneous heel cord tenotomies. Like any

clubfoot

treatment program, this method requires compliant families. They must attend

daily

sessions.

jennylare2004 wrote:

Is this method widely practiced? Is it more prominent in Europe than

in the states?

jenny

[Guest guest]

funny, I just posted this study result on the CF

board. Didn't quite find that other one. Says about the same thing right?

Kori

-8-PASSIVE MOTION MACHINE AND PHYSIOTHERAPY OF CLUBFOOT:

COMPARATIVE STUDY FROM 1988 TO 1995

A. DIMÉGLIO, F. BONNET

(Montpellier)

From 1988 to 1995, 236 clubfeet were classified

during the first months of life and then followed

up at regular intervals. In all series, the feet

were separated into 4 major categories, on the

basis of a score ranging from 0 to 20. Postural

feet, Grade I: Soft-Soft feet with a score of 0

to 5, completely reducible feet were excluded

from the study. Moderate feet, Grade II:

Soft-Stifff feet with a score of 5 to 10 made up

40% of all cases: 94 feet. Severe feet, Grade

III: Stiff-Soft feet with a score of 10 to 15,

made up 42% of cases: 99 feet. Very severe feet,

Grade IV: Stiff-Stiff feet with a score of 15 to

20, made up 18% of cases: 43 feet.

From 1988 to 1991, 84 feet were followed up:

Treatment with manipulation mainly was done at

home, every day. Out of all categories, 76% of feet wer operated.

From 1992 to 1995: 152 feet were followed up and

50% of all feet were operated. A unit was set up

and organised. Manipulations were performed in

rehabilitaiton center, in average every second

week during the first 3 months, and they were

complemented by the use of the passive motion

machine as early as the first few days of life.

The results of orthopedic treatment associated

with the passive motion machine have consistently improved.

From 1992 to 1995, out of 152 feet, 106 were

intensively rehabilitated (41 moderate, 43

severe, 22 very severe). Only 38% of feet were

operated: Out of 41 moderate feet, 2 (i. e. 5%)

were operated, The two feet that were operated

underwent posterior release, and 39 were not

operated, i. e. 95%. Out of 43 severe feet, 22

were operated, 51%: posterior release: 10 feet

(23%), and posteromedial release in 12 feet

(28%), no surgery was performed in 21 feet, i. e.

49%. Out off 22 very severe feet, 16 were

operated (78% ): 5 had posterior release (23%),

10 had posteromedial release (45%), 1 had

posteromedial and lateral release (5%), and 6 were not operated (27%).

From 1992 to 1995, out of 152 feet: 46 feet were

treated by manipulation at home, whithout using

passive motion machine. (19 moderate, 16 severe,

11 very severe). 78% of feet were operated: Out

of 19 moderate feet, 11 i. e. 58% were operated:

posterior release in 4 feet (21%), posieromedial

release in 7 feet (37%) and 8 were not operated,

i. e. 42%, . Out of 16 severe feet, 14 were

operated i. e. 88%. : posterior release: 3 feet

(19%), posteromedial release in 8 feet (50%),

posteromedial release in 3 feet i. e. 19% and no

surgery was performed in 2 feet i. e.12% .0ut of

ll very severe feet, ll were operated, i.e.100%

:posterior release : 2 feet i. e. 18%,

posteromedial release in 2 feet i. e. 18%, and 7

had posteromedial and lateral release, i. e. 64%.

This study allows drawing four conclusions:

1. A properly designed orthopedic performed by

specialised physiotherapists is very advantageously supported by the machine.

2. The first 3 months of life are critical, and

the machine must be used during this period.

3. This demanding method allows reducing not only

the number of children requiring surgery, but

also the extent of surgery. 4. Extensive surgery

with posterior, lateral and medial release has become exceptional.

Diméglio A, Bonnet F, Mazeau Ph, De V:

Orthopaedic Treatment and Passive Motion Machine:

Consequences for the Surgical Treatment of

Clubfoot. JPediatr Orthop ( 1996;5: 173-180.

At 07:35 PM 2/8/2006, you wrote:

>Here is an abstract I just found:

>

> NONOPERATIVE CLUBFOOT TREATMENT USING PHYSICAL THERAPY

> B. s s III, MD

> Holly , PT ­ Dallas, TX

> Objective:

> Determine success rate of the French physical

> therapy program in patients with

> idiopathic clubfeet.

> Methods:

> Eighty-four patients with 125 idiopathic

> clubfeet were evaluated. All were 3 months old or

> less when treatment was begun. Massage of the

> clubfoot followed by taping was

> performed five days per week by experienced

> physical therapists for up to 12 weeks,

> with intermittent visits with the physical

> therapist over the next 12-18 months. Each foot

> was graded for severity using Dimeglio's

> classification prior to treatment (moderate,

> severe, very severe). Eighty-three of the 125

> feet did not have access to adjunctive

> continuous passive motion (CPM). Outcomes

> were classified as excellent (plantigrade

> foot without surgery), fair (percutaneous

> heel cord release or limited posterior release),

> or poor (posteromedial release).

> Results:

> Followup averaged 31 months (range 20-42).

> Moderate feet had 20 excellent, 6 fair, and

> 3 poor outcomes. Severe feet had 40

> excellent, 21 fair, and 17 poor outcomes. Very

> severe feet had 1 excellent, 8 fair, and 9

> poor outcomes. Overall, 49% of patients' feet

> achieved excellent outcomes and 28% fair

> outcomes. Twenty-three percent required

> posteromedial releases to achieve a

> satisfactory plantigrade position. If CPM was not

> utilized, there was slightly higher

> percentage of feet requiring posteromedial release

> (CPM:17%, No CPM:27%).

> Conclusion:

> Half of the idiopathic clubfeet in patients 3

> months old or less treated by experienced

> physical therapists achieve a satisfactory

> plantigrade position without the need for any

> surgical intervention, including percutaneous

> heel cord tenotomies. Like any clubfoot

> treatment program, this method requires

> compliant families. They must attend daily

> sessions.

>

>

>

>jennylare2004 wrote:

> Is this method widely practiced? Is it more prominent in Europe than

>in the states?

>

>jenny

>

>

>

>

>

>