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Has the Rate of Extensive Surgery to Treat Idiopathic Clubfoot Declined in the United States?
Lewis E. Zionts, MD1; Guofen Zhao, MS2; Kristin Hitchcock, MSI2; Jaya Maewal, BS1; Edward Ebramzadeh, PhD1
1 Orthopaedic Hospital, 2400 South Flower Street, Los Angeles, CA 90007. E-mail address for L.E. Zionts: LZionts@laoh.ucla.edu
2 American Academy of Orthopaedic Surgeons, 6300 North River Road, Rosemont, IL 60018-4262
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Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity.

Investigation performed at the Department of Orthopaedic Surgery, Geffen School of Medicine at UCLA; Orthopaedic Hospital, Los Angeles, California; and the American Academy of Orthopaedic Surgeons, Rosemont, Illinois

Copyright ©2010 American Society for Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2010 Apr 01;92(4):882-889. doi: 10.2106/JBJS.I.00819
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In the late 1990s, renewed interest emerged in less invasive treatment options, most notably the Ponseti method, to correct idiopathic clubfoot deformity. Recently, reports from several centers have demonstrated that such minimally invasive techniques may be used reliably to correct this complex deformity. The present study sought to determine whether the rate of extensive surgical releases to treat idiopathic clubfoot in the United States has decreased.


We used data from the Centers for Disease Control and Prevention and the Nationwide Inpatient Sample to determine the number of live births, the number of patients diagnosed with clubfoot, and the number of extensive surgical releases that were performed each year from 1996 to 2006. The trends over time were evaluated with use of regression analysis, and changes in frequency were analyzed with use of time series analysis. The percentage of clubfeet that were treated with surgery in each year was calculated by dividing the number of surgical release procedures by the number of clubfoot diagnoses.


Between 1996 and 2006, the estimated number of patients under six months of age diagnosed with clubfoot remained fairly constant, averaging 2140 infants per year. The linear equation estimated a slight decrease of approximately thirty-one infants with clubfoot per year (R2 = 0.51, p < 0.05). In contrast, in the same decade, the estimated number of surgical releases performed in patients less than twelve months of age decreased substantially, from 1641 releases in 1996 to 230 releases in 2006. The linear equation estimated a decrease of approximately 157 surgical releases per year (R2 = 0.83, p < 0.05). The trend analysis indicated that the percentage of clubfeet treated with surgical release generally decreased over time at a rate of 6.7% per year, decreasing from just over 70% in 1996 to just over 10% in 2006 (R2 = 0.81, p < 0.05).


In the United States between 1996 and 2006, the rate of extensive surgery to treat idiopathic clubfoot in patients less than twelve months old decreased substantially. This trend is likely due to an increased use of less invasive techniques, such as the Ponseti method, which a growing body of evidence has shown to be a viable treatment option for clubfoot.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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