Extract
I read with interest the article entitled "Long-Term Comparative
Results in Patients with Congenital Clubfoot Treated with Two Different
Protocols"
(2003;85:1286-94), by Ippolito
et al. I wish to heartily congratulate Dr. Ippolito and his team for
convincingly demonstrating the unfavorable long-term outcome after extensive
soft-tissue release for the treatment of severe idiopathic clubfoot deformity.
Also, Ponseti's method of manipulation and limited posterior release has been
convincingly offered as a superior alternative. Certainly, this reportedly
more effective method has demonstrated a very impressive long-term outcome. In
essence, this article tends to raise doubts about the widespread and perhaps
empirical use of conventional methods of manipulation and soft-tissue
release1-6.
On the contrary, early soft-tissue release, including varying degrees of
extensive medial release, for the treatment of moderate-to-severe clubfoot
deformity has been an increasingly popular trend for the last two decades with
very promising
results1,2,4,6,7.
However, there was always a lingering suspicion that a minority of patients in
whom the clubfoot resists correction even in early infancy have relapses
repeatedly, even after extensive release, and might indeed have deterioration
in adulthood. This suspicion has now been confirmed. Admittedly, it is not
only very difficult to identify the minority early on during conservative
treatment, and thus prognosticate that the rate of relapse would be
unacceptably high, but their subsequent management is also not without
troublesome
complications5,7.
The difficulty in classifying this minority in a reproducible way has been
repeatedly
emphasized5-7.