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J Pediatr Orthop B. 2017 May;26(3):197-203. doi: 10.1097/BPB.0000000000000423.

The hybrid method for the treatment of congenital talipes equinovarus: preliminary results on 92 consecutive feet.

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aDepartment of Pediatric Surgery, University Hospital Estaing, Clermont Ferrand bUniversity of Montpellier, Faculty of Medicine, Montpellier, France.


Over the past 4 years, our pediatric orthopedic unit has developed a new hybrid protocol combining the advantages of Ponseti's method and the French functional physiotherapy method. Sixty-one patients (92 feet) completed treatment. Clubfoot was unilateral in 30 (49.2%) patients and bilateral in 31 (50.8%) patients. The mean Dimeglio score at the start of treatment was 13.5/20 (range: 6/20-19/20). All patients had clinical and radiographic follow-up for at least 2 years (range: 2-4 years). If orthopedic treatment was ineffective and feet showed no improvement, further surgery was performed. Posterior release was performed in eight (8.7%) feet. Clinical evaluation at the last follow-up found a mean dorsal flexion of 20°±5° (range: 5°-35°). The hybrid method is a combination approach applying the strengths of Ponseti's method, that is, serial casting, and the French physiotherapy method, that is, manipulations and radiographs, to achieve long-term correction with a foot that is fully functional and pain free.

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