Correction of idiopathic congenital clubfoot using the ponseti technique: radiologic assessement

Abstract

Background Clubfoot is a three-dimensional deformity in which the calcaneopedal complex rotates under the talar–tibial–fibular complex. The deformity includes four components: metatarsus adductus, cavus, hindfoot varus, and equinus. The Ponseti method consists of serial manipulation and casting for the correction of cavus, metatarsus adductus, and hindfoot varus; however, equinus is corrected by means of percutaneous Achilles tenotomy. The Ponseti method depends on clinical assessment. In our study, we used radiological assessment in combination with clinical assessment for the evaluation of correction of the clubfeet using the Ponseti method and early detection of pseudocorrection and lastly for the evaluation of the effect of percutaneous Achilles tenotomy on the correction of equinus deformity. Patients and methods Twenty-eight patients with clubfoot (20 patients) were included in this study. There were 12 boys and eight girls and their ages averaged 2 weeks (range=1 day to 3 weeks). All of them were treated with weekly manipulation and casting, followed by fluoroscopic evaluation after the fifth to sixth cast. Percutaneous Achilles tenotomy was performed when the foot could be abducted to 70° in relation to the leg with restoration of the anteroposterior talocalcaneal angle to 30° and the foot can be dorsiflexed to less than 10° with the lateral tibiocalcaneal angle more than 70°. Results Pirani score was used for the assessment of the deformity at presentation, at final removal of cast before bracing, and at latest follow-up. Pirani score improved from average 2.5 at first presentation to 0.5 at final removal of cast, to 0.25 at latest follow-up. At removal of the last cast, the foot could be abducted to an average of 70° in relation to the leg, with restoration of the anteroposterior talocalcaneal angle to an average of 37°, and the foot can be dorsiflexed to an average of 25° above right angle with restoration of lateral tibiocalcaneal angle to an average of 68°. Percutaneous Achilles tenotomy improved equinus by an average of 20° and the lateral tibiocalcaneal angle by an average of 19°. There were no complications such as infection, vascular injury, or recurrence. Conclusion The Ponseti method is an excellent method for the treatment of clubfoot, and we found that the addition of radiographic to clinical evaluation helps in the better assessment of correction and early detection of pseudocorrection to avoid recurrence or development of rocker bottom deformity. All components of clubfoot would be corrected by stretching, but equinus usually needs percutaneous tenotomy, which helps acute correction of the deformity.