Management of idiopathic clubfoot by Ponseti’s method: a comparative clinical study on toddlers with radiological correlation (original) (raw)

2016, International Journal of Research in Orthopaedics

Clubfoot is defined as fixation of the foot in adduction, supination and varus. It is a deformity where the foot points downward with the toes and sole twisted inwards. Three bones the calcaneus, navicular, cuboid are medially rotated in relation to the talus. Idiopathic clubfoot is the commonest congenital deformity of foot. 1 The incidence is about 1:1000 live births with a sex ratio of 2:1showing preponderance among males. The condition is bilateral in about 50% of cases. 24.4% of affected individuals have a family history of idiopathic clubfoot. 2 Most are untreated or poorly treated. Neglected clubfoot causes physical, social, psychological and financial burdens on the patients, their families, and the society. Globally, neglected clubfoot is the most serious cause of physical disability among congenital musculoskeletal disorders. 3 The idiopathic type is primarily a deformity of soft tissue only. Although the primary cause is unknown, but mal-alignment and loss of flexibility of the ABSTRACT Background: In developed countries, many children with clubfoot undergo extensive corrective surgery, often with disturbing failures and complications. The need for one or more revision surgeries is common. Although the foot looks better after surgery, it is stiff, weak, and often painful. Non-operative treatment of clubfoot provides a lower complication rate, less pain, and higher function as the patient ages. Lack of information regarding reasons for adherence to the regimen makes it difficult for health providers and health planners to determine the impact of treatments on health status or weigh the cost/benefit ratio for prescribing costly treatments to the patients. Therefore, it is important to understand how parents and health care givers manage their children's treatment and the potential barriers these parents encounter during the utilization of clubfoot treatment services. It is important to determine the compliance of patients to clubfoot correction treatment in order to identify and target factors that may positively or negatively influence cases attending the clinic. Methods: 25 cases with clubfoot were studied in the Department of Orthopaedics, Katihar Medical College. Out of these, 13 cases (Group A) were children over 1 year of age with neglected clubfoot and 12 cases (Group B) were children under one year of age with idiopathic clubfoot. Results: The Ponseti method delivers excellent correction of clubfoot without the associated risks and complications of major foot surgery. Patients treated with Ponseti's method have leverage in treatment of clubfoot than those treated by other conservative methods. The method provides more flexible foot and ankle than those treated surgically. Conclusions: Treatment of clubfoot if commenced early will have better result. Children of age less than 1 year respond better than children of older age group. Younger children require fewer correction casts.