One-week accelerated PONSETI method in the management of idiopathic clubfeet

Abstract

Purpose: This study aims to evaluate the results of the 1-week accelerated PONSETI method in the management of idiopathic clubfeet implemented by Ahmad and Aker in which manipulations, five castings, and Achilles tendon tenotomy are done in a week. Methods: We studied 15 patients with 22 moderate-to-severe congenital idiopathic clubfeet treated by the 1-week accelerated PONSETI method. The method involves the manipulation of the deformed foot and the first casting in the 1st day, with the second, third, fourth, and fifth castings (if the foot is not fully corrected, additional casting is done till reaching fully initial correction) in the 4th, 5th, 6th, and 7th day postmanipulation. After removal of the last cast, Achilles tenotomy was performed with subsequent 3-week casting in all patients. The Pirani scores were used for comparing the results before starting the treatment and after removal of the final cast. Results: We had 15 patients (7 bilateral and 8 unilateral) of clubfoot. The average age at the treatment was 15.2 days (range = 1–90 days). All patients, who had moderate-to-severe congenital idiopathic clubfeet with a Pirani score of 4–6 (mean = 5.61), underwent the 1-week accelerated PONSETI technique. After removal of the 3-week cast, the scores were 0 for all cases (except 3 feet with Pirani score of 0.5), which was an indication for deformity correction to achieve acceptable feet in all patients without the experience of any short-term complications. Conclusions: Our study of the 1-week accelerated PONSETI technique was found to be safe and effective for the initial correction of severe idiopathic clubfoot deformity in children less than 3 months of age and confirmed the results reported by Ahmad and Aker's study but still needs more follow-up of the patients to confirm the results on the long term.