Is the Denis Browne Splint a Myth? A Long-Term Prospective Cohort Study in Clubfoot Management using Denis Browne Splint Versus Daily Exercise Protocol

• Published in: The Journal of foot and ankle surgery 2020-03, Vol.59 (2), p.314-322
• Main Authors: Sheta, Reda Ali, El-Sayed, Mohamed
• Format: Article
• Language: English
• Subjects: Casts, Surgical; Child, Preschool; Clubfoot - diagnosis; Clubfoot - physiopathology; Clubfoot - therapy; daily exercise program; Exercise - physiology; Exercise Therapy - methods; Female; Follow-Up Studies; Humans; idiopathic clubfoot; Male; Manipulation, Orthopedic - methods; modified Ponseti method; Patient Compliance; Pirani score; Prospective Studies; Reconstructive Surgical Procedures - methods; Recurrence; Splints; stretching program; Tenotomy - methods; Time Factors
• ISSN: 1067-2516; 1542-2224
• DOI: 10.1053/j.jfas.2019.08.026

The Ponseti technique is successful in idiopathic clubfoot management. However, the leading cause of relapse and recurrence is nonadherence to the Denis Brown bracing protocol. This necessitates more extensive soft tissue surgeries. Based on a detailed up-to-date search, we have found that no other studies provide such a modified Ponseti technique. This study is unique, as it depends on using specific stretching exercises instead of bracing during management. Between August 2009 and June 2019, a consecutive series of 194 isolated idiopathic clubfoot patients (251 feet) were included in this study. The mean follow-up was 93 months (range 72 to 146), mean 91.8 months. All patients underwent a clinical and functional assessment using the Laaveg-Ponseti score and radiological assessments. There were 132 boys (68.1%) and 62 girls (31.9%), a male-to-female ratio of 2:1. The mean age at initiation of treatment was 14.9 days. According to the Laaveg-Ponseti score, 51.7% yielded excellent results, 35.3% yielded good results, 11.55% yielded fair results, and 1.59% yielded poor results. Bracing noncompliance has been identified as a major cause for treatment failure. This presented exercise protocol not only eliminates the need for bracing and reduces the cost for the affected individuals but also provides excellent clinical and radiographic end results, comparable to the original treatment protocol using the Denis Brown brace.