Critically Appraised Topic
I am currently completing internship number 3/III at Maitland Cottage pediatric hospital in Newlands South Africa. Children diagnosed with clubfoot at multiple stages are seen weekly by a team of surgeons and physiotherapists. I have noted that the surgeons, as a group, are keen to initiate non-surgical, conservative intervention of Ponseti serial casting as compared to immediate theater surgical intervention. This led me to ask why a surgeon would choose an intervention of stretching, manipulations and serial casting over surgical tendon and soft tissue releases.
Does the Ponseti method of serial casting reduce the need for extensive surgery when used as an intervention to treat children with congenital talipes equinovarus (CTEV) compared to the Copenhagen method?
Clinical Bottom Line
Based on the results of Andriesse and Hagglund, and Aurell et al. there is moderate evidence to suggest that the Ponseti method is better than the Copenhagen method at reducing the need for extensive surgical intervention in infants with congenital idiopathic clubfoot. Both studies showed a statistically significant difference within groups and between groups at p=.05, with the Ponseti method requiring less extensive surgery than the Copenhagen method to achieve adequate correction of the clubfoot deformity. Neither study had a strong PEDro score, but both studies are similar to my clinical PICO in population and outcome measures. Generalizing these outcomes should be done with caution due to the poor internal validity of these studies, small sample sizes, and lack of randomization and blinding. Further research is needed to investigate the long-term effects both these conservative treatments as well as surgical intervention alone. Future studies should include larger sample sizes, blinding, and randomization into groups.
Ford, Jamie, "The therapeutic efficacy of the Ponseti method of serial casting for children with clubfoot" (2014). PT Critically Appraised Topics. 46.