Hyperabduction of Brace Curbs Clubfoot Relapse - Chiropractic Use of Supports and Braces

Hyperabduction of Brace Curbs Clubfoot Relapse
January 2006
HEIDI SPLETE (Senior Writer)
Pediatric News
Elsevier Inc.

WASHINGTON Û Hyperabduction of the last brace to 60%Ò70% significantly reduces the risk of relapse and the need for surgery in children who are treated for clubfeet with the Ponseti method, Matthew E. Lovell said at the annual meeting of the American Academy of Pediatrics.

Mr. Lovell, a medical student at the University of Iowa, Iowa City, and his colleagues studied the effects of increased abduction on clubfoot relapses in a series of 320 patients with 502 clubfeet treated with the Ponseti method between 1948 and 2000.

The Ponseti method involves serial casting and gentle foot manipulation, followed by foot abduction bracing.

The researchers divided the patients into two groups based on the amount of hyperabduction of the last cast and brace. Group I included 291 feet treated between 1948 and 1984 without the maximum abduction; group II included 211 feet that were treated between 1991 and 2000 with the maximum abduction.

Overall, 170 (58%) of patients in group I had at least one relapse, compared with 59 (28%) of patients in group II, Mr. Lovell said.

In addition, the number of surgical releases was significantly higher in group I, compared with group II (11% vs. 4%), as was the number of anterior tibialis transfers (51% vs. 15%).

The groups were similar in gender breakdown, incidence of bilateral deformity, and family history of clubfeet, but the rate of previous nonsurgical therapy in group II was more than double that in group I (77% vs. 33%).

In general, fewer than 10% of treated clubfeet relapse by the time the patient is 5 years old, but the tendency to relapse persists until 12 years of age.

ÏWe suspect that some relapses are due to other neuromuscular diseases,Ó Mr. Lovell said.

Most of the cases of multiple relapse occurred prior to 5 years old, which suggests that noncompliance in the use of the brace was a factor.

© 2006 Elsevier Inc. All rights reserved.