Complications Associated with Ponseti Serial Casting and Surgical Correction via Soft Tissue Release in Congenital Idiopathic Clubfoot.

Background: The current standard treatment used worldwide for management of congenital idiopathic clubfoot is serial casting by Ponseti method. Prior to 2006, standard treatment for congenital idiopathic clubfoot at Siriraj Hospital involved major soft tissue release by any of the following release techniques, modified posteromedial release, complete subtalar release, and posterior release.

Objective: To evaluate the complications and recurrence of deformity associated with treatment of congenital idiopathic clubfoot by Ponseti serial casting and major soft tissue release at Siriraj Hospital.

Material And Method: This retrospective review of medical charts and records was conducted in congenital idiopathic clubfoot patients who underwent primary treatment by either Ponseti serial casting or major surgical soft tissue release between 2000 and 2012 at Siriraj Hospital. Patient demographic, clinical, diagnostic, and surgical procedure-related data were reviewed. All associated complications were recorded and analyzed.

Results: One hundred sixty one patients were included, of which 46 had treatment by Ponseti method and 115 had treatment by major soft tissue release. In the Ponseti group, there were 26 males and 20 females (73 feet), with an average age at the beginning of treatment of 10.70 weeks (range 0.86 to 42.86). The complication rate was 17.8% (13 feet in 11 patients). The most common complications were cast loosening in four feet (5.48%) and cast-associated skin irritation in four feet (5.48%). In patients treated with Ponseti method, second surgery for recurrent deformity was performed in 26 feet (35.61%). In the soft tissue release surgical intervention group, there were 69 males and 46 females (171 feet), with an average age at the beginning of treatment at 52.05 weeks (range 9.86 to 248.71). The complication rate was 12.87% (22 feet in 18 patients). The most common complications were wound infection in nine feet (5.26%), followed by cast loosening in seven feet (4.09%). In soft tissue release patients, second surgery for recurrent deformity was performed in 26 feet (15.20%).

Conclusion: In this study, complication rates relating to clubfoot treatment by Ponseti serial casting and major soft tissue release were 17.8% and 12.87%, respectively. The two most common complications of Ponseti serial casting were cast loosening (5.48%) and cast-associated skin irritation (5.48%). The most common complication of major soft tissue release was wound infection (5.26%), followed by cast loosening (4.09%).