gms | German Medical Science

Objective: The nonoperative treatment of clubfeet with the Ponseti method has gained increasing acceptance as primary treatment modality. Polydactyly is a common congenital limb anomaly occurring both as an isolated defect or as part of a syndrome. To our knowledge, this is the first report of treatment of a severe, hexadactyle clubfoot with the Ponseti method.

Methods: A healthy newborn with bilateral clubfeet (left side: Pirani Score 5; right side: Pirani Score 5.5, hexadactyly with a dysplastic medial row) was treated with the Ponseti method. The first long-leg casts were applied immediately at the first day after birth. The “normal” left clubfoot required five casts whereas the hexadactyle clubfoot required nine casts before being ready for Achilles tenotomy. Two casts instead of one were needed to correct the cavus deformity. Further treatment consisted of splinting with the ALFA-Flex^® Brace. The medial, dysplastic row of the right clubfoot was resected 9 months after birth, when the boy started to stand on his own feet.

Results and conclusions: The hexadactyle foot demonstrated a severe and very rigid deformity; that needed more correcting long-leg casts. Good clinical results could be obtained in both feet (Pirani Score 0.5) one year after initial treatment. A bilateral dorsiflexion of 20 degrees in the ankle joint was achieved. The use of the ALFA-Flex^® Brace in combination with the corresponding open sandals was ideal in this hexadactyle foot. We noticed no pressure ulceration at the supernumerous medial row throughout the treatment period.

The treatment of clubfeet is still a challenge for orthopaedic surgeons. In this hexadactyle clubfoot, the severity of deformity and tightness of ligaments had to be considered. Succesful results require well-founded knowledge of pathoanatomy and established therapeutical options by the treating physician.