Cross Sectional Study of Clinical Profile and Treatment of Clubfoot by Ponseti Method among Infants at a Tertiary Care Hospital

Abstract

Congenital Talipes Equinovarus (clubfoot) is the most common abnormality of foot. Mostly, clubfoot is idiopathic but various environmental and epidemiological factors have influenced the etiology of it. The aim of study was to access clinical profile and efficacy of Ponseti method of treatment in infants. Methodology: It is a cross-sectional study conducted at orthopedic department, Nishtar medical university and hospital, Multan. Duration of study was 3 years, from 10th January 2016 to 10th January 2019. We included 58 (88 clubfeet) infants with age ranges from 2-12 months. Patients suffering from Arthrogryposis multiplex congenita, Meningomyelocele, spina bifida and had past surgical manipulation were excluded. Results: There were 68.9% male and 31% female patients in our study. There were Bilateral 30 (51.7%) children with bilateral TEV while 28 (48.3%) patients with unilateral clubfoot. In our study, 70 percent of the feet were corrected with six serial casting. Achilles tenotomy was needed in 68 (77.2%) feet. We observed pre-treatment Pirani score 5.51 ± 0.62 while post treatment Pirani score was E‚0.5. Excellent outcome was reported in 80 (91%) while remaining 9% left the treatment and didn’t come for follow up. After evaluating birth history we found that 40 (68%) patients were born through spontaneous vertex delivery, 8 (13.7%) needed Caesarian section and 10 (17%) needed episiotomy to facilitate their births. In fifty (56.8%) patients the calf muscles were normal and among 38 (43.1%) were thin. There was no major complication noted. Conclusion: Clubfoot among male is more common than female. There were equal number of cases with bilateral and unilateral clubfoot. Mode of delivery and positive family history had significant association with clubfoot. Patients with early presentation and low pretreatment Pirani score showed excellent outcome as compare to patient presented with high Pirani scoring. Ponseti technique showed excellent outcome in majority of patients in our study. Effective awareness campaigns and counselling of parents can show good compliance to treatment. Training of primary and secondary healthcare professionals should be done in order to calvefacilitate people and share burden of tertiary care hospitals.