Sport Ability during Walking Age in Clubfoot-Affected Children after Ponseti Method: A Case-Series Study

Background: The Ponseti method (PM) of manipulative treatment for congenital talipes equinovarus (CTEV) or clubfoot became widely adopted by pediatric orthopedic surgeons at the beginning of the mid-1990s with reports of long-term successful outcomes. Sports are crucial for children's development and for learning good behavior. This study aimed to evaluate the sports activity levels in children treated with PM and to assess the different outcomes, according to gender and bilaterality. Methods: A total of 25 patients (44 feet) with CTEV treated by the PM were included in the study. The patients were clinically evaluated according to the Clubfoot Assessment Protocol, American Orthopedic Foot and Ankle Society, Ankle–Hindfoot score, the Foot and Ankle Disability Index (CAP, AOFAS, and FADI, respectively), and FADI Sport scores. Results: The overall mean CAP, AOFAS, FADI, and FADI Sport scores were 97.5 ± 6.4 (range 68.75–100), 97.5 ± 5.8 (range 73.00–100), 99.9 ± 0.6 (range 97.1–100), and 100, respectively. Gender and bilaterality did not affect outcome (p > 0.05). Conclusions: The data confirmed good-to-excellent outcomes in children with CTEV managed by PM. No limitations in sport performance or activity could be observed. In particular, male and female patients and patients with unilateral or bilateral involvement performed equally well. Keywords: clubfoot; CTEV; sport; sport practice; sport activity level; young athletes; ponseti method 1. Introduction Congenital talipes equinovarus (CTEV) is one of the most common congenital pediatric orthopedic deformities and is characterized by dorsal hyperflexion of the foot, varus of the hindfoot, forefoot adduction and increased plantar arch [1]. Clinical manifestations may depend on etiology [1], severity, and clinical course [2,3], and different treatment options are available to treat patients with CTEV [4–8]. The Ponseti method (PM) of manipulative treatment for CTEV became widely adopted by pediatric orthopedic surgeons beginning in the mid-1990s, with reports of long-term successful outcomes [9,10]. PM consists of a series of specific manipulations and cast applications to concurrently correct the forefoot, midfoot, and subtalar components of the deformity; a percutaneous Achilles tenotomy is often needed to correct the equinus component. Correction is then maintained for the first few years using a foot abduction orthosis at night and during naps. The aim of the procedure is to achieve a pain-free supple plantigrade foot with a minimal amount of surgery as practicably possible as long-term studies on the outcomes of surgical releases have reported high rates of painful and stiff feet with poor post-surgical functional outcomes [6–10].