The Ponseti method for the treatment of clubfoot is in widespread use around the globe, and while a variety of measures or tools have been used to evaluate outcomes, few have been validated in different contexts, and none have been standardized or universally accepted. Our goal is to review how outcomes are currently reported in the clubfoot literature, and we have chosen to frame the discussion based on a conceptual model, namely the World Health Organization's (WHO) International Classification of Functioning, Disability and Health (ICF). We have chosen to group outcome measures based on whether they are “impairment-based” or “function-based”, the latter being subcategorized as healthcare provider-reported, patient/proxy-reported, or hybrid. Finally, we discuss the limitations of how clubfoot outcomes are currently reported, the challenges in accepting a universal outcome measure, and encourage the clubfoot researchers and clinicians to develop an outcome measure that can be used across cultures and throughout the developed and developing world, to homogenize clubfoot outcome measures and improve the standard-of-care.
Abbas M, Qureshi OA, Jeelani LZ, et al. Management of congenital talipes equinovarus by Ponseti technique: a clinical study. J Foot Ankle Surg 2008;47(6):541–545. DOI: 10.1053/j.jfas.2008.07.002.
Duffy CM, Salazar JJ, Humphreys L, et al. Surgical versus Ponseti approach for the management of CTEV: a comparative study. J Pediat Orthop 2013;33(3):326–332. DOI: 10.1097/BPO.0b013e31827d0b2c.
Spiegel DA, Shrestha OP, Sitoula P, et al. Ponseti method for untreated idiopathic clubfeet in Nepalese patients from 1 to 6 years of age. Clin Orthop Relat Res 2009;467(5):1164–1170. DOI: 10.1007/s11999-008-0600-1.
Gelfer Y, Hughes KP, Fontalis A, et al. A systematic review of reported outcomes following Ponseti correction of idiopathic club foot. Bone Joint Open 2020;1(8):457–464. DOI: 10.1302/2633-1462.18.BJO-2020-0109.R1.
Stucki G, Cieza A, Ewert T, et al. Application of the international classification of functioning, disability and health (ICF) in clinical practice. Disabil Rehabilit 2002;24(5):281–282. DOI: 10.1080/09638280110105222.
Little WJ. A treatise on the nature of club-foot, and analogous distortions; including their treatment both with and without surgical operation. Med Chir Rev 1840;32(64):423–445.
Martin RL, McPoil TG. Reliability of ankle goniometric measurements: a literature review. J Am Podiat Med Associat 2005;95(6):564–572. DOI: 10.7547/0950564.
Chesney D, Barker S, Maffulli N. Subjective and objective outcome in congenital clubfoot; a comparative study of 204 children. BMC Musculoskelet Disord 2007;8(1):53. DOI: 10.1186/1471-2474-8-53.
Agarwal A, Rastogi A. Anthropometric measurements in Ponseti treated clubfeet. SICOT J 2018;4:19. DOI: 10.1051/sicotj/2018010.
Pirani S, Outerbridge HK, Sawatzky B, et al. A reliable method of clinically evaluating a virgin clubfoot evaluation. Vol. 29. In 21st SICOT Congress; 1999. pp. 2–30.
Dimeglio A, Bensahel H, Souchet P, et al. Classification of clubfoot. J Pediat Orthop B 1995;4(2):129–136. DOI: 10.1097/01202412-199504020-00002.
Shaheen S, Jaiballa H, Pirani S. Interobserver reliability in Pirani clubfoot severity scoring between a paediatric orthopaedic surgeon and a physiotherapy assistant. J Pediat Orthop B 2012;21(4):366–368. DOI: 10.1097/BPB.0b013e3283514183.
Fan H, Liu Y, Zhao L, et al. The correlation of pirani and dimeglio scoring systems for Ponseti management at different levels of deformity severity. Scienti Rep 2017;7(1):1–8.
Agarwal A, Gupta N. Does initial Pirani score and age influence number of Ponseti casts in children? Int Orthop 2014;38(3):569–572. DOI: 10.1007/s00264-013-2155-3.
Asuquo J, Anisi C, Abang I, et al. The predictive value of the pirani scoring system. J Pediat Orthop Part B 2019;28(3):296.
Gao R, Tomlinson M, Walker C. Correlation of Pirani and Dimeglio scores with number of Ponseti casts required for clubfoot correction. J Pediatr Orthop 2014;34(6):639–642. DOI: 10.1097/BPO.0000000000000182.
Bensahel H, Dimeglio A, Souchet P. Final evaluation of clubfoot. J Pediat Orthop Part B 1995;4(2):137–141. DOI: 10.1097/01202412-199504020-00003.
Agarwal A, Gupta S, Sud A, et al. Results of modified Ponseti technique in difficult clubfoot and a review of literature. J Clin Orthop Trauma 2020;11(2):222–231. DOI: 10.1016/j.jcot.2019.05.003.
Ahmad AA, Aker L. Accelerated Ponseti method: first experiences in a more convenient technique for patients with severe idiopathic club feet. Foot Ankle Surg 2020;26(3):254–257. DOI: 10.1016/j.fas.2019.03.003.
Altaf KA, Shah SBS, Ahmad S, et al. Results of JESS (Joshi's external stabilizing system) in relapsed, neglected and neurogenic clubfoot in an age group of 2–10 years. Ortop Traumatol Rehabil 2020;22(2):121–129. DOI: 10.5604/01.3001.0014.1170.
Kite JH. Conservative treatment of the resistant recurrent clubfoot. Clin Orthop Relat Res 1970;70(70):93–110. DOI: 10.1097/00003086-197005000-00011.
Ippolito E, Fraracci L, Farsetti P, et al. Validity of the anteroposterior talocalcaneal angle to assess congenital clubfoot correction. Am J Roentgenol 2004;182(5):1279–1282. DOI: 10.2214/ajr.182.5.1821279.
DePuy J, Drennan JC. Correction of idiopathic clubfoot: a comparison of results of early versus delayed posteromedial release. J Pediatr Orthop 1989;9(1):44–48. DOI: 10.1097/01241398-198901000-00009.
Davids JR, Gibson TW, Pugh LI. Quantitative segmental analysis of weight-bearing radiographs of the foot and ankle for children: normal alignment. J Pediat Orthop 2005;25(6):769–776. DOI: 10.1097/01.bpo.0000173244.74065.e4.
Barker SL, Lavy CBD. Correlation of clinical and ultrasonographic findings after Achilles tenotomy in idiopathic club foot. J of Bone Joint Surg Ser B 2006;88(3):377–379. DOI: 10.1302/0301-620X.88B3.17273.
Nasr P, Berman L, Rehm A. Ultrasonographic findings after Achilles tenotomy during Ponseti treatment for clubfeet: is ultrasound a reliable tool to assess tendon healing? J Child Orthop 2014;8(5):405–411. DOI: 10.1007/s11832-014-0610-3.
Watzl MTP, Dos Santos A, Ferreira Neto AL, et al. Ultrasonographic aspects of the Achilles tendon after tenotomy for the treatment of congenital clubfoot by the Ponseti technique. Radiol Bras 2020;53(1):34–35. DOI: 10.1590/0100-3984.2018.0086.
Desai S, Aroojis A, Mehta R. Ultrasound evaluation of clubfoot correction during Ponseti treatment: a preliminary report. J Pediatr Orthop 2008;28(1):53–59. DOI: 10.1097/bpo.0b013e31815a60a6.
Di Marco R, Rossi S, Racic V, et al. Concurrent repeatability and reproducibility analyses of four marker placement protocols for the foot-ankle complex. J Biomechan 2016;49(14):3168–3176. DOI: 10.1016/j.jbiomech.2016.07.041.
Akşahin E, Yüksel HY, Yavuzer G, et al. Quantitative gait characteristics of children who had successful unilateral clubfoot operation. Acta Orthop Traumatol Turc 2010;44(5):378–384. DOI: 10.3944/AOTT.2010.2352.
Baker R, McGinley JL, Schwartz MH, et al. The gait profile score and movement analysis profile. Gait Posture 2009;30(3):265–269. DOI: 10.1016/j.gaitpost.2009.05.020.
Sankar WN, Rethlefsen SA, Weiss J, et al. The recurrent clubfoot: can gait analysis help us make better preoperative decisions? Clin Orthop Relat Res 2009;467(5):1214–1222. DOI: 10.1007/s11999-008-0665-x.
Böhm S, Sinclair M. The PBS Score—a clinical assessment tool for the ambulatory and recurrent clubfoot. J Children's Orthop 2019;13(3):282–292. DOI: 10.1302/1863-2548.13.190077.
Morris C, Liabo K, Wright P, et al. Development of the Oxford ankle foot questionnaire: finding out how children are affected by foot and ankle problems. Child: Care, Health Develop 2007;33(5):559–568. DOI: 10.1111/j.1365-2214.2007.00770.x.
Morris C, Doll H, Davies N, et al. The oxford ankle foot questionnaire for children: responsiveness and longitudinal validity. Qual Life Res 2009;18(10):1367. DOI: 10.1007/s11136-009-9550-7.
Morris C, Doll H, Wainwright A, et al. The Oxford ankle foot questionnaire for children: scaling, reliability and validity. J Bone Joint Surg Br Vol 2008;90(11):1451–1456. DOI: 10.1302/0301-620X.90B11.21000.
Martinkevich P, Møller-Madsen B, Gottliebsen M, et al. Validation of the translated Oxford ankle foot questionnaire in 82 Danish children aged between five and 16 years. Bone Joint J 2015;97(3):420–426.
Banskota B, Yadav P, Rajbhandari T, et al. Outcomes of the Ponseti method for untreated clubfeet in Nepalese patients seen between the ages of one and five years and followed for at least 10 years. J Bone Joint Surg Am 2018;100(23):2004–2014. DOI: 10.2106/JBJS.18.00445.
Bevans M, Ross A, Cella D. Patient-reported outcomes measurement information system (PROMIS): efficient, standardized tools to measure self-reported health and quality of life. Nurs Outlook 2014;62(5):339–345. DOI: 10.1016/j.outlook.2014.05.009.
Khan AA, Abarca N, Cung NQ, et al. Use of PROMIS in assessment of children with Ponseti-treated idiopathic clubfoot: better scores with greater than 3 years of brace use. J Pediat Orthop 2020;40(9):526–530. DOI: 10.1097/BPO.0000000000001556.
Masrouha KZ, Moses MJ, Sala DA, et al. The validity of patient-reported outcome measurement information system (PROMIS) parent proxy instruments to assess function in children with talipes equinovarus. J Pediat Orthop 2019;39(10):e787–e790. DOI: 10.1097/BPO.0000000000001368.
Laaveg SJ. Ponseti IV. Long-term results of treatment of congenital club foot. J Bone Joint Surg Am 1980;62(1):23–31. DOI: 10.2106/00004623-198062010-00004.
Roye BD, Vitale MG, Gelijns AC, et al. Patient-based outcomes after clubfoot surgery. J Pediat Orthop 2001;21(1):42–49. DOI: 10.1097/01241398-200101000-00010.
Evans AM, Perveen R, Ford-Powell VA, et al. The Bangla clubfoot tool: a repeatability study. J Foot Ankle Res 2014;7(1):27. DOI: 10.1186/1757-1146-7-27.
Bensahel H, Kuo K, Duhaime M. Outcome evaluation of the treatment of clubfoot: The international language of clubfoot. J Pediat Orthop Part B 2003;12(4):269–271. DOI: 10.1097/01202412-200307000-00006.
Ezra E, Hayek S, Gilai AN, et al. Tibialis anterior tendon transfer for residual dynamic supination deformity in treated club feet. J Pediat Orthop Part B 2000;9(3):207–211. DOI: 10.1097/01202412-200006000-00012.
Ramanathan A, Herd F, Macnicol M, et al. A new scoring system for the evaluation of clubfoot: the IMAR-Clubfoot scale. The Foot 2009;19(3):156–160. DOI: 10.1016/j.foot.2009.04.001.
Smythe T, Wainwright A, Foster A, et al. What is a good result after clubfoot treatment? a delphi-based consensus on success by regional clubfoot trainers from across Africa. PLoS ONE 2017;12(12):e0190056. DOI: 10.1371/journal.pone.0190056.
Vitale MG, Choe JC, Vitale MA, et al. Patient-based outcomes following clubfoot surgery: a 16-year follow-up study. J Pediat Orthop 2005;25(4):533–538. DOI: 10.1097/01.bpo.0000157999.38424.ba.
Dietz FR, Tyler MC, Leary KS, et al. Evaluation of a disease-specific instrument for idiopathic clubfoot outcome. Clin Orthop Relat Res 2009;467(5):1256–1262. DOI: 10.1007/s11999-008-0700-y.
Perveen R, Evans AM, Ford-Powell V, et al. The Bangladesh clubfoot project: audit of 2-year outcomes of Ponseti treatment in 400 children. J Pediat Orthop 2014;34(7):720–725. DOI: 10.1097/BPO.0000000000000225.
Celebi L, Muratli HH, Aksahin E, et al. Bensahel et al. and International Clubfoot Study Group evaluation of treated clubfoot: assessment of interobserver and intraobserver reliability. J Pediat Orthop B 2006;15(1):34–36. DOI: 10.1097/01202412-200601000- 00007.
Smythe T, Mudariki D, Gova M, et al. Evaluation of a simple tool to assess the results of Ponseti treatment for use by clubfoot therapists: a diagnostic accuracy study. J Foot Ankle Res 2019;12(1):14. DOI: 10.1186/s13047-019-0323-4.