American Podiatric Medical Association
View all recommendations from this societyReleased January 19, 2022
Avoid major reconstructive surgical intervention on children with clubfoot without prior Ponseti casting therapy per standard protocols.
The Ponseti method has become the standard of care worldwide for treatment of pediatric clubfoot deformity. The success rates for clubfoot treatment with the Ponseti method, when properly administered, is 95%. In cases where rigid or neglected deformities are encountered, the Ponseti method can reduce the complexity of the deformity, thereby reducing complexity of surgical intervention and potential complications. Failure to consider Ponseti therapy first, may subject patients to unnecessary surgery and/or more complicated reconstruction attempts that might have otherwise been avoided.
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How The List Was Created
(1–5) The American Podiatric Medical Association’s (APMA) Clinical Practice Advisory Committee, consisting of APMA members, board members, young members and liaisons with special interests in a variety of subspecialty areas within podiatric practice, formulated the recommendations for the ABIM Foundation’s Choosing Wisely Campaign. The Committee worked with podiatric colleagues to create an initial list of recommendations, which was reviewed and narrowed down to eight recommendations. The list of eight recommendations was further developed and distributed to the Committee for ranking in numerical order. Committee members were asked to rank the recommendations based on their relevance, timeliness, strength of supporting evidence and appropriateness for inclusion in the Choosing Wisely Campaign. The rankings and deliberation enabled the Committee to come to the final five recommendations, which were again reviewed to ensure appropriate evidence was used to support each recommendation. The final recommendations were approved by the Board of Trustees of the APMA before submission to the ABIM Foundation.
(6–10) The American Podiatric Medical Association (APMA) tasked their Clinical Practice Advisory Committee consisting of APMA members, board members, young members, and liaisons with special interests in a variety of subspecialty areas within podiatric practice to formulate the recommendations for the ABIM Foundation’s Choosing Wisely Campaign. The Committee worked with podiatric colleagues to create an initial list of recommendations, which was reviewed and narrowed down to nine recommendations. The list of nine recommendations was further developed and distributed to the Committee for ranking in numerical order. Committee members were asked to rank the recommendations based on their relevance, timeliness, strength of supporting evidence and appropriateness for inclusion in the Choosing Wisely Campaign. The rankings and deliberation allowed the Committee to come to the final five recommendations, which were again reviewed to ensure appropriate evidence was used to support each recommendation. The final recommendations were approved by the Board of Trustees of the APMA before submission to the ABIM Foundation.
APMA’s disclosure and conflict of interest policy can be found at www.apma.org.
Sources
Agarwal A, Gupta S, Sud A, Agarwal S. Results of Modified Ponseti Technique in Difficult Clubfoot and a Review of Literature. J Clin Orthop Trauma. 2020;11(2):222-31.
Digge V, Desai J, Das S. Expanded Age Indication for Ponseti Method for Correction of Congenital Idiopathic Talipes Equinovarus: A Systematic Review. J Foot Ankle Surg. 2018;57(1):155-8.
Ferreira GF, Stéfani KC, Haje DP, Nogueria MP. The Ponseti Method in Children with Clubfoot After Walking Age – Systematic Review and Metanalysis of Observational Studies. PLoS One. 2018;13(11):e0207153. Published 2018 Nov 20. doi:10.1371/journal.pone.0207153
Jowett CR, Morcuende JA, Ramachandran M. Management of congenital talipes equinovarus using the Ponseti method. J Bone Joint Surg Br. 2011;93(9):1160-4.
Kowalczyk B, Felus J. Ponseti Casting and Achilles Release Versus Classic Casting and Soft Tissue Releases for the Initial Treatment of Arthrogryphotic Clubfeet. Foot Ankle Int. 2015;36(9):1072-7.
Morcuende JA, Cook TM. The Ponseti Method in Low and Middle Income Countries: Challenges and Lessons Learned. Foot Ankle Clin. 2015;20(4):547-54.
Radler C. The Ponseti Method for the Treatment of Congenital Club Foot: Review of the Current Literature and Treatment Recommendations. Int Orthop. 2013;37(9):1747-53.
Zionts LE, Ebramzadeh E, Morgan R, Sangiorgio S. Sixty Years On: Ponseti Method for Clubfoot Treatment Produces High Satisfaction Despite Inherent Tendency to Relapse. J Bone Joint Surg Am. 2018;100(9):721-8.
