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 common birth defect that affects the musculoskeletal system. The initial treatment is conservative. The Functional physiotherapy method (FPM) is based on mani-pulations of the foot, bandages, splints, and exercises adapted to the motor development of the child to achieve a plantigrade and functional foot with the smallest surgical gesture possible. There are different approaches to the same method, but there is a lack of comparative studies between them. This study describes the results obtained with two approaches of this method [Robert Debré (RD) and Saint-Vincent-de-Paul (SVP)] revealing a significant difference in the ratio of surgeries before and after implementing the SVP method
The motivation behind this study was to detect the most effective FPM approach for maintaining corrections and reducing the rate of surgeries. This is very important because it would translate into saving resources, and would determine whether our institution should continue supporting the application of this method. The results of this study can encourage the implementation of FPM for us by other professionals who are seeking to both improve their interventions in clubfoot and reduce the ratio of surgeries.
The objective of this study was to compare two approaches of the FPM (RD and SVP) with regard to the improvement achieved and the frequency of surgery necessary to achieve a plantigrade foot, and to determine if the choice of one method or another would generate a substantial decrease in the rate of surgeries of clubfoot.
A retrospective review of the therapeutic outcome was carried out for a series of 71 idiopathic clubfeet on 46 children born between February 2004 and January 2012. Data were taken from the medical records. The clubfeet were evaluated and classified 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 hell-cord tenotomy), fair (by limited surgery), and poor (by complete surgery). Comparisons between treatments were performed with the χ2 tests for nominal variables, and U test for numerical ones. The OR test was used for relapse rates. A two-tailed P-value ≤ 0.05 was considered statistically significant.
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). The Dimeglio-Bensahel scale is useful for reflecting the severity of the deformity, and for analyzing the results category by category.
Our hypothesis that the SVP method could achieve prolonged correction of deformities more efficiently than the RD method, as well as decrease the rate of surgeries, was confirmed in this study. The best advantage of the SVP method was the greater number of cases without any surgeries. No new methods were proposed in this study, but we would like to highlight that the SVP method is a clearly beneficial option for the treatment of idiopathic clubfoot.
This study helped emphasize the importance controlling the equine of the calcaneus to avoid the need for surgery, and showed the efficacy of the FPM (the physiotherapy achieves a flexible, functional and painless clubfoot, and substantially reduces the need for surgery). The results obtained correlate with the initial severity of the deformity and with the protocol applied. The success of the treatment is based on two basic pillars: the adherence of parents to treatment and team training. It is essential to inform, educate and train the family, accompanied by a follow-up throughout the growth. We believe that it is necessary to carry out a future prospective investigation applying the SVP method with long-term follow-up. It is important to note that the current results obtained by different teams with the FPM correlate with those reported in the literature of the Ponseti method, and their differences do not reach statistical significance.