Mid-term Results of Ponseti Method for the treatment of Congenital Idiopathic Clubfoot - (A Study of 67 Clubfeet with Mean Five Year Follow-Up)

Milind M Porecha,Dipak S Parmar,Hiral R Chavda

doi:10.1186/1749-799x-6-3

Milind M Porecha, Dipak S Parmar + Show 1 more

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https://doi.org/10.1186/1749-799x-6-3

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Abstract

BackgroundLong-term success reports by Dr. Ponseti with the Ponseti method in the treatment of congenital idiopathic clubfoot have led to a renewed interest in this method among pediatric orthopedists. The purpose of this study is to evaluate mid-term effectiveness of Ponseti method for the treatment of congenital idiopathic clubfoot.Material and MethodsA total of 49 patients (67 clubfeet) were treated by Ponseti method by single orthopedic surgeon during the period of October 03 to July 07 and were studied prospectively up to July 10 (mean follow up period 5 years, minimum follow-up period of 3 years). Age at the initiation of the treatment, gender, bilaterality, severity of the initial clubfoot deformity measured by Pirani Severity Score System, total numbers of Ponseti casts before the tenotomy, details of tenotomy, compliance with brace and CTEV shoes were examined. Passive range of movements and look of club foot are evaluated with mean 5 years follow-up.ResultsWe followed the functional Ponseti Scoring System and got good to excellent results in 44 patients - 89.79% (58 clubfeet - 86.56%) at mean five year of follow up. Parents of 32 patients (65.30%) accept the look of the clubfoot nearly normal and parents of 12 patients (24.49%) accept the look of clubfoot as normal. Of the 49 patients who responded to initial Ponseti casting, 14 patients - 28.57% (19 clubfeet - 28.35%) had relapse at varying age; out of which 9 patients - 64.29% (10 clubfeet - 52.63%) were corrected by Ponseti casting method, while 5 patients - 35.71% (9 clubfeet - 47.37%) were resistant to Ponseti method. Poor compliance with the Denis Browne splint was thought to be the main cause of failure in these patients.ConclusionPonseti method is a safe and satisfactory treatment for congenital idiopathic clubfoot with mid- term effectiveness.

Highlights

Long-term success reports by Dr Ponseti with the Ponseti method in the treatment of congenital idiopathic clubfoot have led to a renewed interest in this method among pediatric orthopedists
Of the 49 patients who responded to initial Ponseti casting, 14 patients - 28.57% (19 clubfeet - 28.35%) had relapse at varying age; out of which 9 patients - 64.29% (10 clubfeet - 52.63%) were corrected by Ponseti casting method, while 5 patients - 35.71% (9 clubfeet - 47.37%) were resistant to Ponseti method
Materials and methods A total of 49 patients (67 clubfeet) were treated by Ponseti method by single orthopedic surgeon during the period of October 03 to July 07 and were studied prospectively up to July 10 at our institute after taking informed consent of parents of patients prior being included into the study and was authorized by the local ethical committee

Summary

Introduction

Long-term success reports by Dr Ponseti with the Ponseti method in the treatment of congenital idiopathic clubfoot have led to a renewed interest in this method among pediatric orthopedists. The purpose of this study is to evaluate mid-term effectiveness of Ponseti method for the treatment of congenital idiopathic clubfoot. If the deformity did not respond most of the surgeons go through Postero-Medial Release of the soft tissue. All of these methods have the potential to be successful when applied correctly, most of the authors have reported a long-term success rate of only 15% to 50% [2,3]. Cooper and Dietz, in a review of the cases of forty-five patients who had been treated by Ponseti and followed for a mean of thirty years, found that, with the use of pain and functional limitation as the outcome criteria, thirty-five patients (78%) had achieved an excellent or good outcome [5]

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