[Clubfoot treatment through the ages: the Ponseti method in comparison to other conservative approaches and operative procedures]. / Klumpfußbehandlung im Wandel der Zeit: Die Ponseti-Methode im Vergleich zu anderen konservativen Therapieansätzen sowie operativen Verfahren.

ABSTRACT

Clubfoot is one of the most common congenital deformities of the musculoskeletal system with incidence rates ranging from 0.6 to 6.8 per 1,000 live births. The treatment of clubfoot historically belongs to one of the oldest orthopedic therapies. By the end of the nineteenth century redressement with various tools, such as clamps, braces and casts was the standard treatment of clubfoot. Through further development of operational capabilities and the fact that soft tissue structures show amore resistant reaction to pressure and strain than the surrounding cartilage and bone, operative therapy was favored in the late twentieth century. Surgical correction involves the release of contracted capsular and ligamentous structures to varying degrees and the lengthening of tendons.In 1963 Ponseti published his method. He recognized that the internal rotation and plantar flexion of the calcaneus is the key deformity. However, his method first became known worldwide at the turn of the millennium as long-term results of release operations showed stiff scar healing and the risk of over-correction as problems in these operations.Many comparative studies have shown the superiority of the Ponseti method regarding invasiveness, primary correction rate, functional outcome and recurrence rate in both idiopathic and non-idiopathic clubfoot. In this article the current literature regarding this will be presented as well as prominent landmarks in the development of clubfoot treatment.