Treatment of congenital idiopathic talipes equinovarus with the Ponseti method

Abstract

Introduction Congenital idiopathic talipes equinovarus (clubfoot) is a complex deformity that can always be treated conservatively if the right technique is followed. The aim of treatment is to correct its five components so that the patient has a functional, pain-free, plantigrade foot, with good mobility and without calluses, and does not need to wear modified shoes. Aim of the work The aim of this study is to present the authors’ experience with the Ponseti technique in correcting clubfoot and to stress the importance of percutaneous tenotomy in management. Patients and methods We treated 21 feet in 15 patients with clubfoot deformity using the Ponseti technique in Aljedaani Hospital, Ibn Sina College for Medical Science, KSA, and El Hussein University Hospital, Alazhar University, Cairo, Egypt, between August 2006 and August 2009. The severity of the initial clubfoot deformity was classified according to the system of Dimeglio and colleagues. Age at the initiation of the treatment, severity of the initial deformity, total duration of the treatment, the details of tenotomy, Denis-Browne splint, and modified shoes were all studied in relation to the recurrence of the deformity. Results The mean number of casts that were applied to achieve correction was six (range 4–9 casts). Tenotomy was performed in 17 feet. In 19 feet, good results were achieved. Two patients developed recurrence of the deformity because of noncompliance of the parents on the use of orthoses. Conclusion The Ponseti method is a safe and effective treatment for congenital idiopathic clubfoot and markedly decreases the need for extensive corrective surgery. The percutaneous tenotomy of tendo-Achilles is an important step in the management. Noncompliance with orthotics has widely been reported to be the main factor leading to failure of the technique. The outcome has no relation with the severity of the deformity, but the younger the age, the less the number of casts needed. The total duration of the treatment is about 2 months and we found almost normal range of motion at the average 2-year follow-up. Parents of 13 patients (87%) found the final appearance of the foot acceptable.