The influence of brace type on the success rate of the Ponseti treatment protocol for idiopathic clubfoot

Abstract

Purpose: The success of the Ponseti method for treating idiopathic clubfoot deformity is dependent on the casting techniques and the adherence of the patient to the foot abduction brace protocol. Newly developed brace designs claim to be more comfortable, to be easier to use and to prevent dislodgement of the foot from the brace, making them more efficient and improving patient compliance. They are, however, more costly, and, therefore, accessible to fewer patients. We compared the compliance and treatment outcome using two brace designs, the traditional simple brace of pre-walking shoes attached to a Dennis Browne (DB) bar and the new sophisticated Mitchell brace. Methods: We compared the functional outcome and compliance with the post-corrective bracing protocol of 38 children with idiopathic clubfoot treated in our institution using two brace designs. Twenty-one chose the DB brace and 17 chose the Mitchell brace. Results: There was no difference in the compliance rate or in the final clinical and radiological outcomes of the two groups after a minimum of 2 years of follow-up. A positive correlation was found between the Pirani score at the beginning of treatment and the final functional score for both groups. Both groups were satisfied with the selected brace. Both groups were equally compliant with the brace protocol. Conclusion: We conclude that new and more expensive brace designs do not necessarily provide better clinical results. Fully corrected foot and a strong family-treating team partnership are crucial to adherence with the brace protocol. © 2010 EPOS.