Abstract
Idiopathic congenital talipes equinovarus (CTEV) is a relatively common complex deformity of the foot that can be successfully managed by the Ponseti method. The purpose of this study was to see if the latter can be effectively administered by non-medical specialists outside a specialist or teaching hospital setting. Retrospective review of 24 children (39 feet) with idiopathic congenital talipes equinovarus managed by a physiotherapist-led service in a district general hospital. The median Pirani score at presentation was 4.5 (mean 4.2, range 1.5-6). The median Pirani score for feet requiring tenotomy was 6 (4.5-6), whereas feet not requiring tenotomy had a median Pirani score of 2.5 (1.5-5). A total of 18 feet (46%) underwent an Achilles tenotomy. Foot correction was achieved with an average of 3.4 (2-6) cast changes in the non-tenotomy group, and an average of 7.5 (5-13) in the tenotomy group. Successful initial correction of the deformity was achieved in 37 (95%) of the feet studied. One patient (2 feet, 5%) failed local conservative management, requiring tertiary referral. Two children (2 feet) have relapsed, requiring further serial casting. No children required open surgical release. Follow-up was for a mean of 31 months (17-50). Early results suggest that a combined consultant/physiotherapist-delivered Ponseti service can be effectively and successfully administered in a district general hospital.
Highlights
Idiopathic congenital talipes equinovarus (CTEV) is a relatively common complex three-dimensional deformity of the foot affecting approximately 1–2/1,000 newborns
We looked at whether similar results could be achieved by our physiotherapydelivered Ponseti service in a medium-sized district general hospital (DGH)
All congenital talipes equinovarus deformities referrals were made to the senior author (C.J.C.) who informed the extended scope practitioner (ESP) (K.B. or M.D.)
Summary
Idiopathic congenital talipes equinovarus (CTEV) is a relatively common complex three-dimensional deformity of the foot affecting approximately 1–2/1,000 newborns. The long-term aims of treatment are a pain-free, flexible, functional foot, with good mobility and tolerating normal footwear. The traditional treatment for clubfoot may involve a combination of initial casting, extensive posterior medial soft tissue releases and bony procedures, followed by further casting [1]. This treatment is associated with significant risks, complications, and a potential for poorer prognosis with patients developing weak, stiff and scarred feet [2, 3]. Follow-up studies have shown that these feet have a higher incidence of pain and their gait is affected [2,3,4]
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