# LEARNING CURVE IN PONSETI METHOD – EVOLUTION IN 5 YEAR-INTERVALS

## TL;DR

This study shows that a surgeon's experience with the Ponseti method for clubfoot reduces treatment time and the number of casts needed, especially in the first five years of practice.

## Contribution

The study demonstrates how surgical experience over time improves outcomes in Ponseti clubfoot treatment.

## Key findings

- Experienced surgeons used fewer casts and achieved correction faster than less experienced ones.
- The mentor's first 5 years required more casts (3.47) than later periods (2.6–2.79).
- Pirani score improved most after the third clinic visit in both institutions.

## Abstract

Evaluate whether the experience of the surgeon could reduce Ponseti treatment time, and a number of cast changes, and the evolution of the Pirani Score.

2 reference centers were evaluated. At Institution 1, 254 patients with idiopathic clubfoot (403 feet) were included, and at Institution 2, 32 patients (51 feet). At institution 1 (mentor), 3 intervals of 5 years each were analyzed. At the Institution 2 (trainee), 1 interval of 5 years was analyzed.

Patients treated by the mentor had fewer casts compared with the trainee (p < 0.001). At Institution 1, the three mentor intervals showed differences in the number of casts (p < 0.05). A statistically significant difference was observed only in the first mentor interval (2000 to 2005, average of 3.47 casts) compared with the 2 other intervals (2005 to 2010; average of 2.6 casts and 2011 to 2015; average of 2.79 casts; p < 0.0001). Pirani score decreases the most until the third clinic visit.

The mentor’s greater expertise was associated with fewer casts and shorter time to obtain correction in isolated clubfoot, especially right after the first 5 years of practice. Progression of the Pirani score in both institutions occurs between the first and the third casts.
Level of Evidence III; Therapeutic Study, Retrospective Comparative Study
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