Management of Idiopathic Clubfoot By Ponseti Method-Our Experience

Abstract

Background: Clubfoot occurs approximately 1 in 1000 live births and is one of the most common congenital birth defects. There have been many reports of successful treatment of idiopathic clubfoot with Ponseti method in the western world, but there are only few studies done in the developing country like India. So the present study was undertaken with the following objective. Objective: To evaluate the efficacy of Ponseti method in the treatment of idiopathic clubfoot. Methodology: A study was conducted from August 2013 to August 2014 in our Hospital attached to PESIMSR. 25 patients (36 clubfoot) were evaluated in our study. All patients were treated by manipulation and casting as described by Ponseti. Main outcome measures included in the study were, the degree of correction of the deformity and the effect of different variables in the course of management. Results: In our study, we treated 25 babies with idiopathic clubfoot by Ponseti method, among them 11 had bilateral affection. The mean age of the babies was 14 weeks. Out of the 25 babies, 30 of the 36 feet had deformity of a severe grade i.e., Pirani score of 5. The mean number of casts required was 5.8. Tenotomy was required for 26 feet. The average number of casts required were increased as age of presentation increases indicating increasing difficulty and delay in correction of babies who presented late. The results were excellent in 64% (16 out of 25) and good in 28% (7 out of 25).The average Pirani score for the group at the presentation was 5.47 (4.5 to 6) and the mean Final Pirani score was 0.25 (0 to 0.5) which was statistically significant. Conclusion: Ponseti method is a very safe, efficient and economical treatment for the correction of clubfoot which radically decreases the need for extensive corrective surgery. The results are excellent when treatment begins early. Keywords: Ponseti method, Idiopathic clubfoot, Pirani score, Tendotomy