Clinical outcomes of idiopathic clubfoot treatment in children using the Ponseti method and maintenance with Mitchell prefabricated foot abduction orthosis at Siriraj Hospital: Case report

Abstract

Introduction: Congenital Talipes Equinovarus (CTEV) is a prevalent foot deformity in infants. The currently recognized global standard to care for CTEV is the Ponseti method. This method involves correcting the deformity through serial casting, followed by a phase of maintenance utilizing a foot abduction orthosis, such as the Mitchell brace, which is crucial for preventing relapse.

Objective: To report the clinical outcomes of treating pediatric patients with CTEV using the Ponseti method and maintenance with the Mitchell brace over a 9-month follow-up period.

Methods: This study is a case series report on three pediatric patients (aged 1–3 months) treated for CTEV at Siriraj Hospital. Data regarding serial casting, Achilles tenotomy, and use of the Mitchell brace were analyzed. Outcomes were evaluated using the Dimeglio score at the initiation of treatment, and during follow-up appointments at 3, 6, and 9 months. (F1, F2, F3)

Results Patients required an average of 4–6 casts during their corrective phases. The initial mean Dimeglio score was 9.30 (from a range of 5–12) and decreased to a mean of 7.60 (from a range of 7–9) at the patient’s final follow-up visit. However, a temporary increase in the mean score (mean: 9.30) was observed during the second follow-up, coinciding with each patient’s transition to foot abduction orthosis use. This change highlights the critical importance of consistent brace wear and parental supervision.

Conclusion This case series of three pediatric patients with congenital talipes equinovarus demonstrates that treatment using the Ponseti method and maintenance with the Mitchell brace leads to a consistent reduction in disease severity over a 9-month follow-up period. Key success factors to prevent relapse include close clinical monitoring and effective parental education on proper brace application.