A Prospective Study on Functional Outcomes of Serial Cast Correction in Congenital Talipes Equinovarus (CTEV) by Ponseti Method.

Abstract

Congenital talipes equinovarus (CTEV), often known as clubfoot, is one of the most common congenital deformities of the foot and ankle, affecting one in every 1,000 live births. The deformity has four components: ankle equinus, hindfoot varus, forefoot adductus, and midfoot cavus. The Ponseti casting technique of CTEV management has proven to be more effective, generating higher positive outcomes and lesser complications than conventional surgical methods. This study was conducted in a tertiary care teaching hospital centre in southern Rajasthan, India. Twenty cases with 31 feet of untreated clubfoot were included. The deformity was scored according to Pirani's scoring system. Manipulation and serial corrective casts were applied at weekly intervals according to Ponseti's method. Percutaneous tendoachilles tenotomy was done whenever required (guided by Pirani score). Final results were calculated using the Pirani score, noted before putting the patient on foot abduction orthosis. In our study, the average numberof casts required for full correction was 6.5. Heel cord tenotomy was required in 27 feet (87%) to achieve full correction. Final Pirani score significantly improved from an average of 4.8 on presentation to 0.055 after completion of casting. We conclude that the Ponseti technique of CTEV correction significantly reduces the need for invasive surgical procedures along with being exceedingly safe, effective, and affordable. The Ponseti technique of cast correction is crucial and provides a painless, plantigrade, cosmetically acceptable foot with higher functional outcomes and minimal complications.