Survey of the POSNA Membership Reveals Variability in Use of Tibialis Anterior Tendon Transfer for Recurrent Clubfoot.

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Abstract

[Indexed for MEDLINE] 16. Bone Joint J. 2014 Oct;96-B(10):1424-6. doi: 10.1302/0301-620X.96B10.33612. The effect of a dedicated Ponseti service on the outcome of idiopathic clubfoot treatment. Mayne AI(1), Bidwai AS(1), Beirne P(1), Garg NK(1), Bruce CE(1). Author information: (1)Alder Hey Children's Hospital, Department of Orthopaedics, Liverpool, UK. We report the effect of introducing a dedicated Ponseti service on the five-year treatment outcomes of children with idiopathic clubfoot. Between 2002 and 2004, 100 feet (66 children; 50 boys and 16 girls) were treated in a general paediatric orthopaedic clinic. Of these, 96 feet (96%) responded to initial casting, 85 requiring a tenotomy of the tendo-Achillis. Recurrent deformity occurred in 38 feet and was successfully treated in 22 by repeat casting and/or tenotomy and/or transfer of the tendon of tibialis anterior, The remaining 16 required an extensive surgical release. Between 2005 and 2006, 72 feet (53 children; 33 boys and 20 girls) were treated in a dedicated multidisciplinary Ponseti clinic. All responded to initial casting: 60 feet (83.3%) required a tenotomy of the tendo-Achillis. Recurrent deformity developed in 14, 11 of which were successfully treated by repeat casting and/or tenotomy and/or transfer of the tendon of tibialis anterior. The other three required an extensive surgical release. Statistical analysis showed that children treated in the dedicated Ponseti clinic had a lower rate of recurrence (p = 0.068) and a lower rate of surgical release (p = 0.01) than those treated in the general clinic. This study shows that a dedicated Ponseti clinic, run by a well-trained multidisciplinary team, can improve the outcome of idiopathic clubfoot deformity. ©2014 The British Editorial Society of Bone & Joint Surgery. DOI: 10.1302/0301-620X.96B10.33612