"An Evaluation of Ponseti Method for the Treatment of Congenital Idiopathic Clubfoot." (original) (raw)

Clubfoot, or talipes equinovarus, is a congenital deformity consisting of cavus, forefoot adduction, heel varus, ankle equinus and internal tibial torsion. The overall prevalence of clubfoot was 1.29 per 1000 livebirths; 1.38 among non-Hispanic whites, 1.30 among Hispanics, and 1.14 among non-Hispanic blacks or African Americans. 1 Unilateral clubfoot is somewhat more common than bilateral clubfoot and may occur as an isolated defect or in association with other disorders (eg, chromosomal aberrations, cerebral palsy, spina bifida, arthrogryposis). Our study aim was to evaluate Ponseti Method for the treatment of congenital idiopathic clubfoot. This was a descriptive cross-sectional study conducted in the dept. of Orthopaedics, Jashore Medical College Hospital during the period from January 2017 to June 2018. Data was collected from patients with idiopathic clubfoot, presenting at selected hospital. Both, unilateral, bilateral were included in the study. In this study, we have treated 46 children with idiopathic clubfoot by Ponseti Method of correction of serial manipulation and casting. Among the 46 children, 24 had unilateral and 22 bilateral involvement. Male were 26 and remaining 20 were female. Most children had grade III and grade IV (Dimeglio et al grading) deformity. The mean number of casts required was 5.66 (4 to 10). Tenotomy was required for 17 patients (37%). The scores for the entire group ranged from 4.0 to 7.0 (of 18) and 4 to 19 (of 28) in the Dimeglio classification. Pirani scores for the age group 0-6 months were 4.44, 6 months to 1 year were 5.28 and 1-2 years were 5.64 respectively. The results were excellent in 36 (82%), good in 7 (15%) and inefficient in 3 (6.52%). Initial and final scores were statistically evaluated with paired "T" test with a "T" value of 37.13 with a "P" value of less than 0.001. Thus there was a significant reduction in the score from the pre level because of intervention. Results: Similar good results and low requirement for surgical interventions other than Achilles tenotomy, which forms part of the Ponseti regimen, were found. In terms of number of patients the success rate is 93.5% and in terms of the number of feet the success rate is 94%. This study demonstrates that treatment of congenital talipes equine varus by conservative management of Ponseti Method can considered as one of the most effective treatment method.