Evidence-Based Treatment for Clubfoot

Abstract

The management of clubfoot has been the subject of active research interest for some time and there is a large body of evidence supporting its treatment strategy. The spectrum of evidence includes randomised controlled trials (RCT), long term prospective follow up as well as systematic reviews including a recent Cochrane review. The actual quality of evidence does vary and there are no real level I studies. Besides, evidence was not always available for the most pertinent clinical questions. However, most published evidence consistently supported the superiority of the Ponseti technique for treating idiopathic clubfoot. Evidence was less clear for management of the complex idiopathic type or the non-idiopathic type clubfoot. Since the publication of results from Ponseti's team this technique has been adopted widely and results published from numerous centres from as far afield as Brazil to Bangladesh. On the basis of available publications it is estimated that the Ponseti technique is in use in at least 113 countries around the world Shabtai et al. (World J Orthop 5:585--590, 2014). The basic principle of the Ponseti technique is well established although minor variations have been attempted by different researchers. In the ensuing paragraphs we have reviewed the evidence base for management of clubfoot recommendations.