Manipulation and brace fixing for the treatment of congenital clubfoot in newborns and infants

Background: As one of the most common congenital deformities in children, clubfoot has long been a challenge for orthopedic surgeons. This paper describes the experience of our team with manipulation and above-the-knee brace fixation without percutaneous Achilles tenotomy for the treatment of clubfoot in newborns and infants. Methods: In the orthopedic department of our hospital, 32 infants and newborns (56 feet) with congenital clubfoot underwent manipulation and above-the-knee brace fixation between 2008 and 2012. External rotation brace was used for 1-4 years during the night after deformity correction. Prospective follow-up for a mean duration of 29 months (range, 12-48 months) was carried out. The efficacy of the treatment was assessed by Pirani's scoring system before and after treatment. Results: Fifty-two feet achieved a normal appearance within 3 to 6 months (average, 4.2 months) after treatment. Two patients had skin pressure sores due to improper brace care, but these healed with no scarring after timely treatment. The mean Pirani score 1 year after treatment was 0.21 +/- 0.09, whereas it was 4.93 +/- 1.02 before treatment (p = 0.0078). No patient required treatment with percutaneous Achilles tenotomy. Conclusion: The manipulation and brace fixation used in this study offer an effective method for correcting clubfoot deformity in newborns and infants. This treatment can be an alternative choice to percutaneous Achilles tenotomy.