The Ponseti and French taping methods have reduced
the incidence of major surgery in congenital idiopathic clubfoot
but incur a significant burden of care, including heel-cord tenotomy.
We developed a non-operative regime to reduce treatment intensity
without affecting outcome. We treated 402 primary idiopathic clubfeet
in patients aged <
three months who presented between September
1991 and August 2008. Their Harrold and Walker grades were 6.0%
mild, 25.6% moderate and 68.4% severe. All underwent a dynamic outpatient
taping regime over five weeks based on Ponseti manipulation, modified
Jones strapping and home exercises. Feet with residual equinus (six
feet, 1.5%) or relapse within six months (83 feet, 20.9%) underwent
one to three additional tapings. Correction was maintained with
below-knee splints, exercises and shoes. The clinical outcome at
three years of age (385 feet, 95.8% follow-up) showed that taping
alone corrected 357 feet (92.7%, ‘good’). Late relapses or failure
of taping required limited posterior release in 20 feet (5.2%, ‘fair’)
or posteromedial release in eight feet (2.1%, ‘poor’). The long-term
(>
10 years) outcomes in 44 feet (23.8% follow-up) were assessed
by the Laaveg–Ponseti method as excellent (23 feet, 52.3%), good
(17 feet, 38.6%), fair (three feet, 6.8%) or poor (one foot, 2.3%).
These compare favourably with published long-term results of the
Ponseti or French methods. This dynamic taping regime is a simple
non-operative method that delivers improved medium-term and promising
long-term results. Cite this article:
