Treatment of idiopathic club foot after the walking age: a systematic review.

Introduction Ponseti´s Method efficacy in newborns have led to widen the indications in older patients. A systematic review of the literature was performed to: 1) Define the degree of scientific evidence of Ponseti´s method in children over 1 year-old with clubfoot; 2) Assess the number of casts and associated procedures required to accomplish full correction; 3) Determine the percentage of full corrected patients; and, 4) Identify the rate of recurrence and complications related to this method Methods Any paper referred to Ponseti´s Method after walking age was selected using PubMed, Ovid and Cochrane as our databases. Our Inclusion criteria were papers with patients over a year old, with > 1 year follow-up, more than 5 patients, published until May 1st 2014. Papers selected should mention correction rate, complications, cast number, and associated procedures required to achieve full correction. Results Eleven papers met the inclusion criteria. The sample consisted in 449 patients. The average age at the beginning of treatment was 3.8 years (range 1 to 18).The average follow up was 31 months. An average of 8 (4-12) casts was required to accomplish full correction. Plantigrade feet were achieved in 75%. Eighteen out of 417 feet presented minor complications (4.3%), without impact on the final result. Discussion Current evidence regarding Ponseti’s method for patients over 1 year-old is primarily Level IV. Eventhough requires higher number of casts and associated procedures; deformity correction is safely achieved in most patients