French Functional Method for Congenital Clubfoot: 20 years of experience
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The document summarizes 20 years of experience using the French Functional Method (FFM) for treating congenital clubfoot. It describes the FFM protocol which involves serial casting and splinting without extensive surgery. A retrospective study of 145 children (210 clubfeet) treated with FFM at a Belgian hospital is presented. Results showed good/excellent outcomes in 86% of cases, with a recurrence rate of 7.69% in compliant patients. Compliance was highest (88%) in the subgroup where tenotomy was introduced. The FFM is presented as a conservative alternative to the Ponseti method, with benefits including less need for tenotomy and high compliance due to its modularity.
French Functional Method for Congenital Clubfoot: 20 years of experience
- 1. French Functional Method for Congenital Clubfoot: 20 years of experience R. Elbaum* B.Noel* V.Degueldre** P.Ghyselinck*** * Department of Orthopaedic surgery, CHIREC Orthopaedic Group (Brussel) ** Department of Physiotherapy , Etterbeek Ixelles Hospital , Brussel , Belgium *** Faculty of Medicine Free University of Brussel (ULB) Belgium
- 2. Disclosures I, (R.Elbaum) DO NOT have a financial interest/arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context of the subject of French Functional Method for congenital Clubfoot
- 3. Principles of conservative treatment of CCF As soon as possible!!! Antiquity Middle Age Industrial period Modern Period Today
- 4. Introduction • Conservative treatment for Congenital clubfoot (CCF), especially the Ponseti method, has showed the advantage on surgery. • Laaveg SJ, Ponseti IV. Long-term results of treatment of congenital club foot. J Bone Joint Surg Am 1980 • Ponseti IV, Smoley EN. Congenital club foot: the results of treatment. J Bone Joint Surg Am. 1963
- 5. Introduction • Another conservative method, developed in France ,the “French”Functional Method (FFM) is presented. • The “Saint Vincent Protocol” describe by Pr. Raphael Seringe (Paris) • Méthode fonctionnelle versus Ponseti dans le traitement du pied bot varus équin
- 7. Aim of the Study • Results? • Surgery and tenotomy? • Compliance and follow-up? • Recurrence rate ? • Advantages and limits ?
- 8. History of French Functional Method (FFM) • 1950 P.Masse @ Daniel • 1970 G.Bensahel @ Guillaume • 1973 R.Seringe @ R.Chedeville • 1985 P.Souchet @ Delaby • 1993 P.Wicart @MJ Clio-Assouvie • 1994 [email protected]
- 9. Protocol
- 10. Protocol
- 11. Protocol
- 12. Protocol *Wicart/Chotel, Rev Chir Orthop 2008
- 13. Protocol • Jo till 4w : 5 x w • 6w à 3mo: 3- 4 x w • >4 mo :1/w to 1/mo • Night Splint till 5-7 Yo www.pied-bot.fr
- 14. Our Serie Retrospective study Since 1994,175 children (230 CCF) were treated in our Institution. 145 children (210 CCF) were evaluated on. Inclusion criteria: o Idiopathic CCF o <3Mo o No previous treatment o walking age 0.3669 0.223 0.4101 0 0.05 0.1 0.15 0.2 0.25 0.3 0.35 0.4 0.45 DROITE GAUCHE BILATÉRAL Laterality Droite Gauche Bilatéral 64% 36% 0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 GARÇON FILLE Gender garçon fille
- 15. Our Serie 4 subgroups = 4 periods of time corresponding to major modifications of the protocol: • Subgroup 1 (1996-1998): no tenotomy • Subgroup 2 (1998-2005): progressive onset of tenotomy. • Subgroup 3 (2005-2014): more pronounced derotation of splints • Subgroup 4 (2014-2016): addition of an anterior hull in the splints. 0 10 20 30 40 50 60 70 Subgroup 1 Subgroup 2 Subgroup 3 Subdroup A Colonne1
- 16. Our Serie 0.0657 0.2879 0.4898 0.1414 0 0.1 0.2 0.3 0.4 0.5 0.6 GRADE 1 GRADE 2 GRADE 3 GRADE 4 Dimeglio Classification grade 1 grade 2 grade 3 grade 4
- 17. Result Ghanem I, Seringe R Rev.Chir.orthop, 1995 ; 81 :616-21 Statistical analysis: - Descriptive study using absolute and relative frequencies - Chi2 test for qualitative variables - Tests considered significant at the 5% .
- 18. Result 5.26 9.23 22.81 38.46 59.65 32.31 12.28 20 GARÇON FILLE Dimeglio according Gender Grade 1 Grade 2 Grade 3 Grade 4 Bergerault F, Fournier J, Bonnard C. Idiopathic congenital clubfoot: Initial treatment Pediatric Orthopedics Department, Clocheville Hospital, Tours University Hospital, 37044 Tours, France p=0,006
- 19. Result P=0,05 12 Hereditary Clubfoot PALMER, R. Clinical Orthopaedics and Related Research: 1964 - Volume 33
- 20. Dorsal flexion evolution -30 -20 -10 0 10 20 30 40 Time Dorsal flexion (°) Ponseti Functional Calcaneopedal bloc derotation evolution -40 -20 0 20 40 60 80 Time Derotation (°) Ponseti Functional Comparaison of 2 methods of treatment for clubfeet: functional and Ponseti method R.Elbaum, MD ,B. Noel, P-L Docquier, MD, PhD EPOS 2011 Prospective study 42 clubfeet (in 28 newborns) 19 boys and 9 girls Two groups – Functional treatment (French method according to Seringe- Chedeville): 22 feet – Ponseti method: 20 feet Clinical evaluation of the feet according to the Dimeglio scoring for clubfeet: Day 0, Weeks 2, 4 and 6, Months 4 Radiographic evaluation : 4 months Souad El Batti, Federico Solla,Virginie Rampal, Méthode fonctionnelle versus Ponseti dans le traitement du pied bot varus équin. RCOVolume 100, Issue 7, Supplement, November 2014,
- 21. Result • El Batti S, Solla F, Clément JL et al. Initial treatment of congenital idiopathic clubfoot: Prognostic factors. Orthop Traumatol Surg Res. 2016 Dec;102(8):1081-1085.
- 22. Result Grade 2 Grade 3 Grade 4 0 10 20 30 40 50 60 70 80 Very Good Good Fair Poor Result without grade 1 Grade 2 Grade 3 Grade 4
- 23. Result according subgroup 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Sous groupe 1 Sous groupe 2 Sous groupe 3 Sous groupe 4 60 11.32 86.77 83.33 30 81.13 8.82 16.67 10 1.89 1.47 0 0 5.66 2.94 0 Excellents Trés bons Moyens Mauvais p = 0,00001
- 24. Need for Surgery Comparison of different conservative treatments for idiopathic clubfoot: Ponseti's versus non-Ponseti's methods. J Int Med Res. 2017 Jun;45(3): Epub 2017 May 28. He JP, Shao JF1, Hao Y
- 26. Result : Role of Tenotomy
- 27. Gait lab analysis The effect of tenotomy on kinematics, kinetics and pressure parameters in children with idiopathic clubfoot R. Elbaum3,4, C. Mahieu1,7, C. Concessa1, F. Adam6, B. Noel7, B. Beyer1, F. S. Van sint jan1, V. Feipel5, 1 , P. Salvia1, 2
- 28. Result: Compliance Rate COMPLIANCE FOLLOW UP (Mo) SUBGROUP 1 90% 55 SUBGROUP 2 88% 37 SUBGROUP 3 83% 61 SUBGROUP 4 70% 50 TOTAL 86% 48
- 29. Compliance rate in the litterature
- 33. Recurence according compliance 73.33 92.31 26.67 7.69 0 10 20 30 40 50 60 70 80 90 100 1 2 3 Pas de récidive Récidive Non compliant compliant p = 0,023
- 34. Recurence rate in the littérature +/- 30%! Relapse of Clubfoot after Treatment with the Ponseti Method and the Function of the Foot Abduction Orthosis Dahang Zhao, MD, Jianlin Liu, MD, Li Zhao, MD,corresponding author and Zhenkai Wu, MD Dobbs MB, Rudzki JR, Purcell DB, Walton T, Porter KR, Gurnett CA. Factors predictive of outcome after use of the Ponseti method for the treatment of idiopathic clubfeet. J Bone Joint Surg Am 2004;86(1) Thacker MM, Scher DM, Sala DA, van Bosse HJ, Feldman DS, Lehman WB. Use of the foot abduction orthosis following Ponseti casts: is it essential? J Pediatr Orthop 2005 Chen RC, Gordon JE, Luhmann SJ, Schoenecker PL, Dobbs MB. A new dynamic foot abduction orthosis for clubfoot treatment. J Pediatr Orthop 2007 Avilucea FR, Szalay EA, Bosch PP, Sweet KR, Schwend RM. Effect of cultural factors on outcome of Ponseti treatment of clubfeet in rural America. J Bone Joint Surg Am 2009 Ramirez N, Flynn JM, Fernandez S, Seda W, Macchiavelli RE. Orthosis noncompliance after the Ponseti method for the treatment of idiopathic clubfeet: a relevant problem that needs reevaluation. J Pediatr Orthop 2011 Haft GF, Walker CG, Crawford HA. Early clubfoot recurrence after use of the Ponseti method in a New Zealand population. J Bone Joint Surg Am 2007 Ponseti IV. Relapsing clubfoot: causes, prevention, and treatment. Iowa Orthop J 2002;22:55–56.
- 35. FFM an alternative to Ponseti Method in developping country ?
- 38. CONCLUSION FFM is an interesting approach for treating clubfeet, especially concerning rigourous and modularity of splinting system. Compliance rate is very high comparing to PM Achilleus tenotomy is less systematic in our series and is indicated after 4 month of age Long term follow up and result encourages us to continue on this way. However, it requires a well-trained physical therapist team and a good collaboration of the parents.
- 39. The Future
- 40. TODA RABA