Abstract
Actually conservative treatment and/or minimal invasive surgical approach is considered the gold standard in the treatment of CF all around the world.
Two main italian pediatric hospitals (Bambino Gesù in Rome and Meyer in Florence) will present own series in order to realize how the two methods (Ponseti in Rome and Seringe in Florence) can be used, the right indications for each method and sharp limits as well.
The aim of this study is to compare two methods for evaluating their effectiveness and their applicability.
Patients, Methods and Results
Rome series: from 1998 to 2009 pediatric hospital Bambino Gesù in Rome had treated 1350 patients with the Ponseti method (1980 feet).
All feet had been scored according to Pirani classification.
At age of 3–4 months, the 72% of feet treated had minimal surgery consisted in transversal tenotomy of achille's tendon. Casting for further 3 weeks and Denis-Brown splint wore full time until walking age and during the night only for 3 years after walking age.
Surgery had been performed in 72% of case and surgery has been directly related to CF severity.
Florence series: the Unit of Pediatric Orthopaedics Meyer Children's Hospital of Florence was born in January 2004 and therefore the series includes patients from January 2004 to December 2009.
173 patients (239 feet) were treated. Dimeglio's classification was used. At the age of 4–5 months were treated with tenotomy of Achille's tendon 51,9% of patients, mainly stage 3, and immobilization in long leg cast was used only for three weeks after surgery.
Discussion
Minimally invasive treatment for CF is universally considered one of the best way to correct the deformity without using the extensive surgery that often causes stiffness, pain and shoes discomfort in adulthood.
The long-term results of two series are similar and this enhance our mind that not invasive method for CF treatment is effective, low-cost, with very low rate of recurrence, only if applied following strictly the protocol. In our series in fact the highest rate of recurrence concerns the missing of Denis-Brown device or early dismission of Denis-Brown as well.
The adherence to the protocol is chiefly recommended by the authors when surgery is not performed and therefore the risk of recurrence is higher.
The French method especially needs a skill panel of physical therapist that are in confidence with the bandage manoeuvres.
Only medical operators in confidence with the methods are able to guarantee good results and a low rate of recurrence as well. For this reason the method recommended by Dr. Seringe is easy exported in geographic areas where health service and health support are well represented.
