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To The Editor: I read with interest the article entitled “Long-Term Comparative Results in Patients with Congenital Clubfoot Treated with Two Different Protocols” (2003;85:1286-94), by Ippolito et al. I wish to heartily congratulate Dr. Ippolito and his team for convincingly demonstrating the unfavorable long-term outcome after extensive soft-tissue release for the treatment of severe idiopathic clubfoot deformity. Also, Ponseti's method of manipulation and limited posterior release has been convincingly offered as a superior alternative. Certainly, this reportedly more effective method has demonstrated a very impressive long-term outcome. In essence, this article tends to raise doubts about the widespread and perhaps empirical use of conventional methods of manipulation and soft-tissue release1-6. On the contrary, early soft-tissue release, including varying degrees of extensive medial release, for the treatment of moderate-to-severe clubfoot deformity has been an increasingly popular trend for the last two decades with very promising results1,2,4,6,7. However, there was always a lingering suspicion that a minority of patients in whom the clubfoot resists correction even in early infancy have relapses repeatedly, even after extensive release, and might indeed have deterioration in adulthood. This suspicion has now been confirmed. Admittedly, it is not only very difficult to identify the minority early on during conservative treatment, and thus prognosticate that the rate of relapse would be unacceptably high, but their subsequent management is also not without troublesome complications5,7. The difficulty in classifying this minority in a reproducible way has been repeatedly emphasized5-7. In this minority of … Corresponding author: Ernesto Ippolito, MD Department of Orthopaedic Surgery University of Rome “Tor Vergata” Viale Oxford 81 00133 Rome Italy e.ippolito{at}mclink.it |
