Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jun 18, 2019; 10(6): 235-246
Published online Jun 18, 2019. doi: 10.5312/wjo.v10.i6.235
Functional physiotherapy method results for the treatment of idiopathic clubfoot
Noriela Carmen García-González, Jorge Hodgson-Ravina, Armando Aguirre-Jaime
Noriela Carmen García-González, Jorge Hodgson-Ravina, Armando Aguirre-Jaime, Servicio de Rehabilitación, Servicio de Ortopedia y Traumatología, Unidad de Investigación Clínica y Experimental, Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife 38010, Spain
Armando Aguirre-Jaime, Colegio de Enfermería, Laureate International Universities, Santa Cruz de Tenerife 38001, Spain
Author contributions: García-González NC conceived the study and helped with design, performed procedures, acquired data, analyzed results and wrote the manuscript; Aguirre-Jaime A helped with study conception and designed the study, and with the writing of the manuscript, processed data, and interpreted results; Hodgson-Ravina J performed procedures and collected data; All authors reviewed and approved the final version of manuscript prior to submission.
Institutional review board statement: This study was reviewed and approved by The Ethics Committee of Nuestra Señora de Candelaria University Hospital.
Informed consent statement: Parents were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each parent agreed to standard treatment by verbal consent.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Noriela Carmen García-González, BSc, MSc, Physiotherapist, Servicio de Rehabilitación, Hospital Universitario Nuestra Señora de Candelaria, Carretera del Rosario 145, Santa Cruz de Tenerife 38010, Spain.
Telephone: 34-92-2-602310 Fax: +34-92-2-600597
Received: March 18, 2019
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.

Keywords: Congenital clubfoot, Clubfeet, Talipes equinovarus, Conservative treatment, Physical therapy, Physiotherapy techniques, Conservative methods

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.