The Classic: Congenital Club Foot: The Results of Treatment

This Classic article is a reprint of the original work by Ignacio V. Ponseti and Eugene N. Smoley, Congenital Club Foot: The Results of Treatment. An accompanying biographical sketch on Ignacio V. Ponseti, MD, is available at DOI 10.1007/s11999-009-0719-8 and a second Classic article is available at 10.1007/s11999-0090721-1. This article is 1963 by the Journal of Bone and Joint Surgery, Inc., and is reprinted with permission from Ponseti IV, Smoley EN. Congenital Club Foot: The Results of Treatment. J Bone Joint Surg Am. 1963;45:261–344. The Association of Bone and Joint Surgeons 2009 Richard A. Brand MD & Clinical Orthopaedics and Related Research, 1600 Spruce Street, Philadelphia, PA 19103, USA e-mail: [email protected] Since 1948, a uniform system of treatment has been applied to all cases of congenital club foot on the Orthopedic Service of the State University of Iowa. Our aim has been to obtain a supple, well corrected foot in the shortest possible time. An end-result study of severe club-foot deformities in otherwise normal children treated initially in this department from 1948 to 1956, with a follow-up period from five to twelve years, is here presented. Three hundred and twenty-two patients with club-foot deformity were treated during this period. The following were not included in this study: One hundred and fortynine patients had been originally treated in other clinics and were referred to us for further correction. Ten patients had arthrogryposis; four had a complete or partial absence of the tibia; and eighteen had a myelomeningocele. The sacrum was absent in two and congenital constriction was present in the legs above the malleoli in two patients. In forty-six patients, the foot deformity was mild and was corrected by simple manipulations or the application of one to three plaster casts. Of the remaining ninety-one otherwise normal children with severe untreated club-foot deformities, twenty-four were lost to follow-up, usually at the end of the initial treatment. We were able to evaluate the results of treatment in only sixty-seven patients with a total of ninety-four club feet. All these deformities were severe, although many variations in the degree of rigidity of the feet were present. The age of the patient at the onset of treatment ranged from one week to six months, and the average age was one month. Of the sixty-seven patients studied, ten were female and fifty-seven were male. The deformity was, therefore, almost six times as prevalent in male as in female children. Forty patients had only one foot deformed (60 per cent) and twenty-seven patients had both feet deformed (40 per cent). In the patients with unilateral involvement, the right foot was deformed in eighteen and the left foot in twenty-two cases. Anteroposterior and lateral roentgenograms and photographs of the feet of all patients were made at the onset of treatment and again at the time of the final