Abstract
The objective of this study was to evaluate the outcomes of the Ponseti manipulation and casting method for clubfoot in a tertiary hospital in Zimbabwe and explore predictors of these outcomes. A cohort study included children with idiopathic clubfoot managed from 2011 to 2013 at Parirenyatwa Hospital. Demographic data, clinical features and treatment outcomes were extracted from clinic records. The primary outcome measure was the final Pirani score (clubfoot severity measure) after manipulation and casting. Secondary outcomes included change in Pirani score (pre-treatment to end of casting), number of casts for correction, proportion receiving tenotomy and proportion lost to follow up. A total of 218 children (337 feet) were eligible for inclusion. The median age at treatment was 8 months; 173 children (268 feet) completed casting treatment within the study period. The mean length of time for corrective treatment was 10.2 weeks (9.5-10.9 weeks). Of the 45 children who did not complete treatment, 28 were under treatment and 17 were lost to follow up. A Pirani score of 1 or less was achieved in 85% of feet. Mean Pirani score at presentation was 3.80 (SD 1.15) and post-treatment 0.80 (SD 0.56, P-value <0.0001). Severity of deformity and being male were associated with a higher (worse) final Pirani score. Severity and age over two were associated with an increase in the number of casts required to correct deformity. This case series demonstrates that the majority (80%+) of children with clubfoot can achieve a good outcome with the Ponseti manipulation and casting method.
Highlights
Congenital talipes equinovarus (CTEV), a deformity commonly called clubfoot, is a complex congenital condition affecting the foot
This study examines the outcomes of the corrective phase for clubfoot as recommended by the Ponseti method in a cohort of children undergoing treatment at one referral hospital in Zimbabwe
A total of 218 children (337 feet) with a diagnosis of idiopathic clubfoot presented for treatment (Figure 1); 28 children were excluded from analysis as they had yet to 218 children with idiopathic clubfoot
Summary
Congenital talipes equinovarus (CTEV), a deformity commonly called clubfoot, is a complex congenital condition affecting the foot. It presents with varying degrees of rigidity that is not passively correctable [1]. Untreated clubfoot results in pain and disability [2]. The incidence of clubfoot varies globally [3] and it is estimated that 80% of children born with clubfoot each year live in low- and middle-income countries (LMICs) [4]. Boys are affected 2.5 times as often as girls, and the condition is bilateral in half of the cases [5]. The causes of clubfoot are poorly understood, but may include genetic factors [6]
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call