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New Study From Orthopaedic Institute for Children Finds Increase in Relapse Rate Over Time After Clubfoot Treatment

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A just-released study conducted at Orthopaedic Institute for Children in Los Angeles has revealed important new evidence concerning the treatment of clubfoot, a congenital deformity of one or both feet that occurs in one out of every 1,000 births each year.

As published in the May issue of The Journal of Bone and Joint Surgery, the study shows that for patients whose clubfeet were initially corrected using the Ponseti method—the preferred technique to manage clubfoot deformity—the rate of relapse and the percentage of feet requiring a joint-sparing surgical procedure increase with time. As a result, clinicians who manage clubfoot deformity need to be aware of the possibility of relapse during middle and late childhood; and, thus, follow-up with these patients beyond age seven years or perhaps until skeletal maturity may be warranted.

The Ponseti method is presently the standard of care for the management of clubfoot deformity in children. Developed in 1948 by Ignacio Ponseti, M.D., the technique was slow to be adopted as most orthopaedic surgeons preferred extensive surgery. The method did not gain wide acceptance until the early 2000s, facilitated by social networking. The method involves the correction of a clubfoot through stretching, casting and bracing. A cast is applied each week as the doctor slowly stretches and moves the foot toward the proper position. Once the foot is in proper alignment, the child must wear a brace for the next two years to maintain the correction. The Ponseti method has been proven to be extremely effective, but it requires active participation of the parents to prevent a relapse. The method avoids early pain and stiffness of feet treated by extensive release surgery.

Relapse is a common problem that can be easily addressed. Most early relapses result from non-compliance due to insufficient use of post-corrective bracing. Late relapses may also occur; however, in the medical literature a wide range of relapse rates have been reported.

"We conducted this study so that clinicians could accurately counsel families whose infants are beginning deformity correction using the Ponseti method," said lead researcher Hannah M. Thomas. "We now know that relapses may occur up to and beyond seven years of age, so parents should be aware of the possibility of relapse during late childhood. Repeat cast treatment alone or followed by a joint-sparing surgical procedure is the preferred method for managing a relapsed deformity in an older child."

Thomas points out that early detection of relapse, before osseous changes take place, is useful to facilitate this treatment. "And while it may be possible to rely on parents to recognize an early relapse, another option would be continued follow-up of these patients, on an annual or biennial basis, until skeletal maturity."

The study—performed through a comprehensive literature search—was conducted at the J. Vernon Luck, Sr., M.D., Orthopaedic Research Center on the downtown campus of OIC. In addition to Thomas, researchers included OIC faculty members Sophia N. Sangiorgio, Ph.D.; Edward Ebramzadeh, Ph.D.; and Lewis E. Zionts, M.D. The research center, known as JVL, is internationally recognized for advances in implant performance, including wear, fixation, retrieval analysis and clinical outcome as well as fracture, healing and repair.

OIC is home to a renowned clubfoot clinic whose team of specialty-trained physicians, cast technicians, orthotists and physical therapists work together to ensure that every child is making the right progress to reach that all-important goal: to walk, run and play just like any other child. An IRB-approved database of more than 300 infants treated at OIC has been established and used to study all aspects of clubfoot treatment.

About Orthopaedic Institute for Children

Orthopaedic Institute for Children was founded in 1911 as Los Angeles Orthopaedic Hospital. Focused solely on musculoskeletal conditions in children, OIC receives more than 70,000 patient visits each year. In alliance with UCLA Health and with the support of the OIC Foundation, we advance pediatric orthopaedics worldwide through outstanding patient care, medical education and research. Our locations in downtown Los Angeles, Santa Monica, Westwood and Calexico treat the full spectrum of pediatric orthopaedic disorders and injuries. For more information, visit us at ortho-institute.org.

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