Correction of clubfoot by ponseti method - Our experience

Abstract

Background: Congenital idiopathic clubfoot is a complex deformity which occurs in an otherwise normal child. The Ponseti method of clubfoot management has been shown to be effective, producing better results and fewer complications than traditional surgical methods. Weekly manipulation and plaster casting reduce the deformity. Most feet also require a percutaneous Achilles tenotomy. The correction is maintained by a foot abduction brace (Dennis Browne splint). Recent studies suggest that the Ponseti method can be successful in up to 98% of feet. Objective: The purpose of this study was to assess the results of correction of idiopathic clubfoot by Ponseti method and its complications in children below 2 years of age. Methodology: It is a prospective study in 37 children below 2years of age with idiopathic clubfoot treated by Ponseti method. The study was conducted from august 2016 to august 2018 in Yashoda Superspeciality Hospital, Hyderabad. Observation and Analysis: The mean age of the patient’s was 35 weeks (0-120). Of 37 patients, 25 children presented between 0-6 months, 6 between 6 to 12 months and 6 between 1- 2 years. Among 37 children, 29 were male and 8 were female. Most children had grade III and grade IV (Dimeglio et al. grading) deformity. The average number of casts was 5.1, 5.5 and 7.4 for the age groups 0-6 months, 6 months to 1 year and 1-2 years respectively. The mean number of casts required was 5.76 (4 to 10). Tenotomy was required in 51 feet (100%). The scores for the entire group ranged from 4.0 to 7.0 (of 10) and 4 to 19 (of 20) in the Dimeglio classification. Pirani scores for the age group 0- 6 months were 4.46, 6 months to 1 year were 5.36 and 1-2 years were 5.75 respectively. The results were excellent in 88.3% and good in 11.7%.The mean of initial and final Pirani score is 3.52083 with a ‘ p’ value is 0.000 which is less than 0.01 hence they are statistically significant. Conclusion: Congenital talipes equinovarus (C.T.E.V) is the commonest of all the foot deformities being commoner in male children and bilateral in 66% of cases, idiopathic type being the commonest form. We conclude that the Ponseti method is safe and effective treatment for congenital idiopathic clubfoot in children up to 6 years of age.