Outcomes of Clubfoot Treated With Casting in Ghana.

Aditya Yadavalli,William Hennrikus,Scott Reichenbach

doi:10.7759/cureus.14046

Abstract

Objective: Idiopathic clubfoot deformity is a condition in pediatric orthopedics with a prevalence of 1 in 1000. This study reports the outcomes of clubfoot treatment in Ghana.Methods: The study was Institutional Review Board (IRB) approved. Patients with clubfoot were treated by the Ponseti method including weekly casting, Achilles tendon lengthening (TAL), and prolonged bracing. Data points collected included: extent of clubfoot, age, relapse, tenotomy prevalence, and number of casts.Results: Out of 1,634 patients, 72.4% were less than a year of age at the time of the first cast, 82.6% had more than eight casts prior to bracing, and 74.0% had a percutaneous Achilles tenotomy prior to the final cast placement. Only 1.2% of patients suffered a relapse.Conclusion: In Ghana, delays in seeking in treatment are common. Optimal results for the Ponseti treatment occur in children who present prior to the age of one. In the current study, 27.6% of children delayed treatment until after one. We recommend a community advocacy program to educate leaders and medical personnel about the Ponseti method. Despite a delay of treatment in 25% of the patients, there was only a 1.2% relapse rate. We recommend the Ponseti method in Ghana for children of all ages.

Highlights

Idiopathic clubfoot deformity is a common condition in pediatric orthopedics with a prevalence of about 1.2 in 1000 [1]
The purpose of the current study is to report on the CURE Ponseti treatment program, tenotomy rate, and relapse rate of clubfoot in Ghana, Africa
Because all of the newborns in Ghana with clubfoot were not included in the CURE registry, the exact prevalence of clubfoot in Ghana during 2015 could not be determined

Summary

Introduction

Idiopathic clubfoot deformity is a common condition in pediatric orthopedics with a prevalence of about 1.2 in 1000 [1]. Many regions of the developing world are not able to treat clubfoot deformity due to a variety of barriers to care including a lack of resources, distance to travel, and misunderstanding of disease [1]. The inadequate surgical care of children in developing countries has not been without consequences. In many of these countries, congenital anomalies go unrepaired [1]. The consequences of pediatric surgical conditions may be life-long since they affect children at critical times during development [1]. If the deformity is not casted or treated appropriately within the first few years of the child’s life, there could be serious consequences [4,5,6,7]. The goal of treatment of clubfoot is a normal functioning, pain-free, plantigrade foot with no need for supplemental casting or shoe modifications [9]

Methods

Results

Conclusion