A Home Stretching Program to Prevent Recurrence of Clubfoot Deformity after Treatment with Ponseti Technique - การดัดเท้าเพื่อการป้องกันการกลับเป็นซ้ำของโรคเท้าปุกแต่กำเนิดภายหลังรักษาด้วยวิธีของพอนเซติ

Abstract

                       Ponseti casting technique is reported to have a high success rate in the treatment of idiopathic clubfoot. Recurrence after correction is not uncommon and may lead to recasting or surgery. So a new home stretching program was introduced to parents of patients with a view to reducing the recurrence rate and avoiding the foot abduction orthosis. Forty-nine idiopathic clubfeet treated by Ponseti technique and followed for at least 3 years were included in this study. All of the patients achieved initial correction by casting alone or casting and tendo achilles tenotomy. Home stretching scheme adapted from Ponseti manipulation technique was introduced to parents after the last cast was removed. Forty-seven of the 49 feet (96%) complied with the home stretching scheme. There were 19 recurrent feet.  Seventy-four percent of the recurrent cases occurred within 4 months after the last cast. No recurrence found after 8 months from the last cast. The oldest age at which recurrence occurred was 1 year and 2 months old. No recurrence found after these patients started walking. Of the 19 recurrent feet, three feet were successfully treated by recasting only, twelve feet by recasting and percutaneous tendo achilles tenotomy, two feet by recasting and percutaneous tendo achilles lengthening. Two feet needed more extensive surgeries, one foot had open tendo achilles lengthening and posterior release, and one foot had posterior-medial release. This new home stretching program after initial correction of idiopathic clubfoot achieved high rate of compliance and avoided further extensive surgeries in most cases.

Key words:      clubfoot, Ponseti technique, home stretching, recurrence