Published online Jun 18, 2019. doi: 10.5312/wjo.v10.i6.235
Peer-review started: March 19, 2019
First decision: April 15, 2019
Revised: May 9, 2019
Accepted: May 21, 2019
Article in press: May 22, 2019
Published online: June 18, 2019
Idiopathic clubfoot is a congenital deformity of multifactorial etiology. The initial treatment is eminently conservative; one of the methods applied is the Functional physiotherapy method (FPM), which includes different approaches: Robert Debré (RD) and Saint-Vincent-de-Paul (SVP) among them. This method is based on manipulations of the foot, bandages, splints and exercises adapted to the motor development of the child aimed to achieve a plantigrade and functional foot. Our hypothesis was that the SVP method could be more efficient than the RD method in correcting deformities, and would decrease the rate of surgeries.
To compare the RD and SVP methods, specifically regarding the improvement accomplished and the frequency of surgery needed to achieve a plantigrade foot.
Retrospective study of 71 idiopathic clubfeet of 46 children born between February 2004 and January 2012, who were evaluated and classified in our hospital according to severity by the Dimeglio-Bensahel scale. We included moderate, severe and very severe feet. Thirty-four feet were treated with the RD method and 37 feet with the SVP method. The outcomes at a minimum of two years were considered as very good (by physiotherapy), good (by percutaneous heel-cord tenotomy), fair (by limited surgery), and poor (by complete surgery).
Complete release was not required in any case; limited posterior release was done in 23 cases (74%) with the RD method and 9 (25%) with the SVP method (P < 0.001). The percutaneous heel-cord tenotomy was done in 2 feet treated with the RD method (7%) and 6 feet (17%) treated with the SVP method (P < 0.001). Six feet in the RD group (19%) and twenty-one feet (58%) in the SVP group did not require any surgery (P < 0.001).
Our study provides evidence of the superiority of the SVP method over the RD method, as a variation of the FPM, for the treatment of idiopathic clubfoot.
Core tip: We have compared the clinical results of the treatment of idiopathic clubfoot in the context of the improvement accomplished and the frequency of surgery needed to achieve a plantigrade foot with two Functional physiotherapy methods: Robert Debré (RD) and Saint-Vincent-de-Paul (SVP). Both approaches managed to avoid complete surgery, which shows that the physiotherapies achieve a more flexible foot, allowing a more conservative surgery. Our data indicate that the SVP method achieves prolonged correction of deformities more efficiently than the RD method; the best advantage of the SVP method over the RD method was the greater number of cases without any surgery.