To study the outcome of congenital talipes equinovarus by ponseti method

Abstract

Background: Congenital talipes equinovarus (CTEV) is a common but still not fully understood disorder of the lower limb. It is usually defined as a fixation of the foot in abduction, supination and varus. Different treatment options exist including the Ponseti method. Aim: The aim of the study is to find the effectiveness of Ponseti’s technique of plaster cast application in correction of idiopathic congenital talipes equinovarus and to assess the results using Pirani scoring system. Patients and Methods: Thirty six patients (55 clubfeet) were enrolled at the clubfoot clubfoot clinic in the department of Orthopaedics, Maharaja Agrasen Medical College, Agroha, Hisar from August 2015 to 31st October 2017 Results: In this study 26 patients (72.2%) were male, the anomaly was bilateral in 19(52.8%) cases, unilateral left side in 7(19.4%) and the right side in 10(27.8%). Mean age of presentation was 4.055 months. Clinical evaluation was performed using the Pirani’s scoring system. Mean follow up was 9.16 months: range 6-18 months. An average of 6.69 casts were applied to achieve correction. Only 2 patients (3 feet) required tenotomy which was not corrected by casting. Early starting of casting and longer period of casting helped us decreasing rate of tenotomy. Percentage of cases with relapse at follow up was 9.09% (5 feet) which were treated with recasting again by Ponseti method. In this study mean Pirani’s score at the time of presentation was 5.072 and mean Pirani’s score after 6 month’s follow-up was 0.263. Excellent results were found in 44 feet (80%) i. e. Pirani score of 0. Conclusions: The present study has justified that Ponseti method of manipulation and casting is an effective method to manage congenital talipes equinovarus upto 2 years of age. Ponseti method is capable of achieving painless, plantigrade, normal looking foot. However a longer duration of follow-up and larger sample size is needed to further evaluate the recurrences and to completely justify the effectiveness of Ponseti method.