PMID- 34423012 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20210824 IS - 2305-5839 (Print) IS - 2305-5847 (Electronic) IS - 2305-5839 (Linking) VI - 9 IP - 13 DP - 2021 Jul TI - Narrative Review of the objective analysis of long-term outcome of the Ponseti technique: experience from Dallas. PG - 1100 LID - 10.21037/atm-20-7180 [doi] LID - 1100 AB - In 2001, Texas Scottish Rite Hospital for Children (TSRH) prospectively began a clubfoot database that included all of our patients with clubfeet who were willing to enroll. Nonoperative treatment, primarily the Ponseti method, was utilized. This article summarizes the experience from Dallas treating idiopathic clubfeet using the Ponseti technique, and is based on previously published studies utilizing information from the database. Patient clinical outcomes were defined as "good" (plantigrade foot achieved either with or without a percutaneous heel-cord tenotomy), "fair" (a plantigrade foot that required a limited procedure, such as tibialis anterior tendon transfer or posterior release), or "poor" (a plantigrade foot that required posteromedial release). Nearly 95% of idiopathic clubfeet obtained initial correction using the Ponseti technique, but relapses occurred and by age two years 24% needed some surgical intervention, usually limited procedures. Use of Dimeglio's rating system before treatment strongly correlated with the probability of a "good" outcome at two years. Objective measurements of brace wear compliance (iButton) in those who reached age two years with "good" outcomes demonstrated an unexpected pattern of diminishing use of the foot abduction orthoses over the first two years of brace wear. By the 18-month period of brace wear, 1/3 patients wore the orthoses less than 6 hours per day, and nearly half of the patients wore the orthoses less than 8 hours per day. Between ages 2-5 years, nearly 21% of the corrected clubfeet at age two years needed limited procedures to maintain/regain plantigrade positioning. Lateral weight-bearing radiographs between 18-24 months were not helpful in predicting future relapse in these patients, and are no longer routinely obtained. Following these patients for normal development is important, as nearly 9% of infants initially presenting as idiopathic clubfeet were eventually found to have another disorder including neurological, syndromic, chromosomal, or spinal abnormalities. We continue to emphasize the need to devote great attention to detail when using the Ponseti method in an effort to optimize the clinical outcomes. CI - 2021 Annals of Translational Medicine. All rights reserved. FAU - Richards, B Stephens AU - Richards BS AD - Department of Orthopaedic Surgery, Chief Medical Officer, Texas Scottish Rite Hospital, University Texas Southwestern, Dallas, Texas, USA. LA - eng PT - Journal Article PT - Review PL - China TA - Ann Transl Med JT - Annals of translational medicine JID - 101617978 PMC - PMC8339867 OTO - NOTNLM OT - Clubfoot OT - Ponseti OT - Texas Scottish Rite COIS- Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/atm-20-7180). The series "Clubfoot" was commissioned by the editorial office without any funding or sponsorship. Dr. BSR reports grants from Pediatric Orthopaedic Society of North America, outside the submitted work. The author has no other conflicts of interest to declare. EDAT- 2021/08/24 06:00 MHDA- 2021/08/24 06:01 PMCR- 2021/07/01 CRDT- 2021/08/23 06:38 PHST- 2020/10/29 00:00 [received] PHST- 2021/01/19 00:00 [accepted] PHST- 2021/08/23 06:38 [entrez] PHST- 2021/08/24 06:00 [pubmed] PHST- 2021/08/24 06:01 [medline] PHST- 2021/07/01 00:00 [pmc-release] AID - atm-09-13-1100 [pii] AID - 10.21037/atm-20-7180 [doi] PST - ppublish SO - Ann Transl Med. 2021 Jul;9(13):1100. doi: 10.21037/atm-20-7180.