Effectiveness of French Physiotherapy in Treating Congenital Clubfoot Deformity
*ANM Muyedul Islam1, Sk Akthar Ahmad2, Md Rashedul Kabir3, Md. Kaoser Bin Siddique4 and Atia Arefin5
1Bangabandhu Sheikh Mujib Medical University, Bangladesh
2Bangladesh Institute of Health Sciences, Bangladesh
3Consultant (Physiotherapy), Jatiya Protibondhi Unnaayan Foundation
4Manager- Research, Evaluation & Development (RED) Department, Lion Mukhlesur Rahman Foundation (LMRF)
5Master of Public Health, North South University
Submission: May 08, 2016;; Published: May 23, 2016
*Corresponding author: A.N.M. Muyedul Islam, MPhil in Public Health, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh, Tel: 01199074102; Email: email@example.com
How to cite this article: ANM M I, Sk Akthar A, Md Rashedul K, Md. Kaoser B S, Atia A. Effectiveness of French Physiotherapy in Treating Congenital Clubfoot Deformity. Ortho & Rheum Open Access J. 2016; 2(3): 555588. DOI: 10.19080/OROAJ.2016.02.555588
Clubfoot is the most common congenital structural deformity that leads to physical impairments in children in many developing countries. Neglected clubfoot has been found to be a common cause of physical disability globally among children and young growing adults. The purpose of this study was to investigate the effectiveness of French physiotherapy in treating congenital clubfoot deformity. This cross sectional study was conducted among 102 parents and data were collected by face to face interview with semi-structured questionnaire. Statistical Package for Social Science (SPSS) was used to analyze the data. The mean age of the participants was 405 days. Unilateral limbs were more affected than bilateral limbs. Results shows that out of 30(100%) children with clubfoot deformity, 17(56.7%) were completed cured under French Physiotherapy while 8(26.7%) were completed cured under Ponseti method, almost equal number of children were in both group improved to moderate cured. There was significance difference found between two groups after intervention (p<0.05). French physiotherapy was more effective method for the treatment of clubfoot over the Ponseti method
Keywords: French Physiotherapy; Congenital Clubfoot
Disability has emerged as a major public health problem worldwide. Childhood disability is one of them and it remains hidden in developing country like Bangladesh . Importance of conservative treatment in congenital clubfoot has been known since the Hippocrates era (approximately 400 B.C) . Continuous passive movement treatment method of French authors has also been added to manipulation, bandage, cast and device applications . There is not a clear opinion in the literature on how to treat overcorrection. In the long-term follow-up studies, weakness in muscle groups around the ankle, joint stiffness was found [4,5]. Laaveg & Ponseti  obtained 89% success rate by using the conservative treatment method and minimal invasive surgery if required. Prevalence of congenital clubfoot in Bangladesh is high and most of the cases remain untreated or poorly treated . According to French physiotherapy method (93-96%) so congenital clubfoot is manageable if the treatment can be started before child’s 1st birth day. It is important to identify the effectiveness of French physiotherapy in treating congenital clubfoot deformity than other conservative method like Ponseti Method. In French method the complication should be minimize. As there no study was done in this topic before in our country, I was very much interested to do research on this topic.
Treatment allocation: Treatment procedure was allocated
randomly in two groups by tossing. The heads were taken in odd
serial i.e. group -1 while the tails were placed in even serial i.e.
Group-1: This group was treated by Ponseti method [8-15].
Group-2: This group was treated by French physiotherapy
methods. This treatment will carry out by a team with large
experience in managing clubfoot with such a method [16,17].
In this study the sample size was taken as 30 for both group i.e
Ponseti Method and French Physiotherapy Method.
Study place: The study was carried out at
NGO- TLMB (Gaibandha), SEID Trust.
Study period and duration: From 14th January 2013 to 13th
Data were gathered by pre verified semi structured
questionnaires and in face to face interview. Information about
pregnancy related question, family history & other characteristics
was also obtained. The field work was conducted from March to
September 2013 at Comilla & Dhaka district. The respondents
were selected consecutively who will meet the inclusion and
exclusion criteria. Two interviewers were trained for four days
by the author. The training was consisted of lectures on how
to fill up the questionnaires and mock interviews between
Data analysis: Computer technology (SPSS 20.0) version was
used for classification, presentation and analysis of data.
The Pirani score is a simple. The components are scored as
Each component may score 0, 0.5 or 1
Hind foot contracture score (HCFS): Mid foot contracture
Posterior crease Medial crease
Empty heel Curvature of lateral border
Rigid equinus Position of head of talus (Table 1).
The mean age of the participants was 405 days, n=17 (28%)
participants in between 0-90 days of age, n=8 (13%) in between
91-180 days of age and n=1 (2%) in between 181-270 days. n=4
(7%) participants in between 271-360 days of age, n=10 (17%)
in between 361-450 days of age and n=6 (10%) in between 451-
540 days. n=3 (5%) participants in between 541-630 days of
age, n=5 (8%) in between 631-720 days of age and n=6 (10%)
in between 721-810 days. Result shows that 0-90 days are
more common age those who had taken French physiotherapy
& ponseti method. In control group the participants 21 out of
30(70%) were male and 9 out of 30 (30%) were female. Result
shows that male was more affected than female. In intervention
group the participants 21 out of 30(70%) were male and 9 out
of 30 (30%) were female. Result shows that the male was more
affected than female (Table 2).
In terms of father occupation in ponseti group, out of
30(100%), 5(16.7%) were service holder while the equal
number of service holders in French physiotherapy method
group, 13(43.3%) were business holders in ponseti group while
the equal proportion of respondents were business holders in
French physiotherapy method group. Only 13% were farmers in
ponseti group whereas the double proportion of fathers were
farmers in France physiotherapy method group. Of the fathers in
ponsity group 23% were day labor while the half of proportion
were day labor in French group. In terms of father education
almost equal proportion of fathers was same education level in
both groups. Mother occupation indicates that almost all were
house makers in both groups. Educational status was also same
in both groups (Figure 1).
The above figure shows that almost equal proportion of
father were same occupation in ponseti and French group. The
majority were involved in business (Table 3).
Result shows that among all the participants in Group A,
unilateral n=47(78%) among them n=23(38%) were right limb
affected & n=24(40%) were left limb affected and bilateral
n=13(22%) were involvement of the affected limb of the
participants. Result shows that unilateral limbs were more
affected than bilateral limbs (Table 4).
Result shows that among all the participants approximately
5% (3 of 60) had past family history of clubfoot and 95% (57 of
60) had no past family history of club foot. Of them 2(6.7%) were
in ponseti group and 1(3.3%) were in French Physiotherapy
group (Table 5).
In both group 10% baby was preterm while 86% was born
in time in ponseti group and 83.3% was in French group, the rest
3.3% in ponseti group and 5% was in France group was born
in post term. Of the children with clubfoot deformity 60% had
normal mode of delivery in ponseti group while 66.7% had in
French group. Cesarean delivery had 40% in ponseti group and
33.3% had in French group. Problem during pregnancy occurred
0% in poseti group and 3.3% in French group. Place of delivery
was home, hospital and clinic, the majority of the children’s
place in delivery was home in both groups. It was about fifty
percent. Only 13.3% had clinic in ponseti group and 16.7% in
French group. Only 3.3% mothers had suffered problems during
delivery while the rest had not suffered any problems during
delivery. Of the mothers almost fifty percent had health workers
during delivery, others had no health workers. Out of 30(100%)
children, only 3.3% had other disability and it was in ponseti
group (Table 6).
Results shows that out of 60(100%) children with clubfoot
deformity equal numbers of them were in both group with severe
and moderate deformity. There was no significance difference
between two groups before intervention (p>0.05) (Table 7).
Results shows that out of 30(100%) children with clubfoot
deformity, 17(56.7%) were completed cured under French
Physiotherapy while 8(26.7%) were completed cured under
Ponseti method, almost equal number of children were in both
group improved to moderate cured. There was significance
difference found between two groups after intervention
(p<0.05). France physiotherapy was more effective method for
the treatment of clubfoot over the Ponseti method (Table 8).
The above table shows that there was significance difference
found between two methods in terms of clubfoot treatment
(t=2.9, p=0.005). The calculated mean score was 1.1 and .53
in Ponseti and French physiotherapy method respectively.
French Physiotherapy was more effective treatment for clubfoot
The present study showed French physiotherapy was
more effective method for the treatment of clubfoot over the
Ponseti method. A study reporting early results of the Ponseti
treatment, 95% of the deformities were corrected without need
for extensive surgery . This recovery rate is consistent with
the results, reported by Herzenberg et al. , whose study
included similar population and follow-up. Though it was not a
new treatment method, Ponseti method had not been adopted
by many and surgical treatment methods had been used as
standard treatment until recent years. Initially, extensive surgical
methods aimed physical improvement but owing to long term
follow-up studies the importance of functional outcomes and
maintenance of movement were recognized [20,21]. Muscular
weakness and biomechanical changes [22-23], observed in
patients who were considered as corrected initially, increased
the popularity of conservative treatment methods again. Cooper
& Dietz , found functionally and clinically perfect and good
outcomes in 78% of deformities in patients, who were treated by
Ponseti, in their average 30 years, follow-up study. This success
rate was 85% in control group, consisting of the patients without
congenital foot deformity. In their magnetic resonance imaging
study, Pirani et al.  detected improvement in both the
relation of tarsal bones and the forms of osteochondral outlines
of the bones in patients, treated by Ponseti method. These
findings support the Ponseti’s hypothesis, which asserts that
with a proper treatment method that considers the functional
anatomy of foot and uses biological potential in the tissues of a
newborn, an appropriate improvement can be obtained in most
of the deformities which is contradictory with the present study.
The present study shows that there was significance difference
found between two methods in terms of clubfoot treatment
(t=2.9, p=0.005). Different conservative treatment methods have been suggested in the literature. One of the popular methods in
Europe is the method of Dimeglio et al.  consisting of daily
physiotherapy and continuous passive motion machine.
With this method, only 28% of the cases required surgical
treatment. However, difficulties in long term physiotherapy,
and its high cost makes adoption of this method problematic
in many countries, including our country. In many countries,
especially in the USA, Kite’s method has been used widely for
a long time . Kite, who tried to correct the components of
the deformity separately and patiently, obtained improvement
within 36 weeks. Ponseti attributes such a delay in improvement
to the effort for correction of forefoot by counter pressure
from calcaneocuboidal joint, which was Kite’s error according
to Ponseti. Because kinematics of the foot does not allow
evertion of calcaneus before abduction (outward rotation) of
it, correction of varus became time consuming for Kite . In
a careful study, by Tümer et al.  where Kite’s and Ponseti’s
manipulation methods were used concomitantly, it was reported
that 33% of the cases were treated by only using plaster cast.
This success rate reached at 41% with addition of the patients
who underwent posterior release surgery. Bursalı  reported
that they obtained correction in all of the untreated cases and
in 75% of the cases, treated previously elsewhere, by using
Ponseti’s method strictly.
100% accuracy was not possible in any research so that
some limitation may exist. Regarding this study, there were
some limitations or barrier to consider the result of the study.
The first limitation of this study was sample size. It was taken
only 30 samples in each group. A very few researches have been
done on a few of research among the effectiveness of French
physiotherapy in management of clubfoot patients. So there was
little evidence to support the result of this project study in the
context of Bangladesh.
This study demonstrates that French physiotherapy method
is an effective and reproducible method for correction of
idiopathic Congenital Clubfoot deformities. Furthermore, it may
be used in our country widely. For successful outcomes, this
technique should be applied carefully and the patients should
use the foot abduction orthosis with full compliance. For patient
compliance, besides parent training, producing proper and
comfortable shoes is required.