Método Ponseti no tratamento do pé torto congênito idiopático em um serviço de assistência pública à saúde

Abstract

Introduction: Congenital Clubfoot (CF) is the most common congenital musculoskeletal deformity in humans. Inadequate treatment can lead to severe functional limitations in adulthood and reduced quality of life. The Ponseti Method, a minimally invasive approach, has demonstrated global success, but data on its effectiveness in public healthcare services in Brazil are still sparse. Objective: To evaluate the effectiveness of the Ponseti method in the treatment of idiopathic CF in a public medical assistance healthcare service. Method: A retrospective longitudinal cohort study was conducted with individuals admitted up to 2 years of age at the Brasília hospital of the Sarah Rehabilitation Hospitals Network between January 6, 1997, and November 22, 2023. Epidemiological data were collected, and the application of the Ponseti method was evaluated in two periods: 2009-2017, with the use of ankle-foot orthosis (AFO), and 2017-2023, with the use of abduction orthosis. Results were assessed using recurrence rates, residual deformities, and the modified Laaveg-Ponseti scale. Results: From 1997-2009, 1,386 individuals were treated with the traditional method, with 93.5% undergoing posteromedial surgery. From 2009-2023, 552 individuals underwent the Ponseti method, comprising 72.7% male, 27.3% female, and 52.5% with bilateral involvement, totaling 842 treated feet. The Pirani classification was used from 2017-2023, with an average score of 5.5 at admission. 92.5% of cases underwent Achilles tenotomy after cast changes. The mean follow-up time was 10.3 years in the first period and 5.3 years in the latter, with an average number of cast changes of 7.4 and 6.2, respectively. Comparing the AFO and abduction orthosis groups, a p-value< 0.05 was found for recurrence (71.9% vs. 31.2%), a p-value< 0.05 for modified Laaveg (good/excellent 69.3% vs. 81.8%), and a p-value < 0.05 for residual deformity (67.7% vs. 43%). Conclusion: The Ponseti method is effective in correcting CF, consistent with existing literature. The use of AFO results in more recurrence, residual deformity, and worse functionality, thus advocating for the routine use of abduction orthosis.