Evaluation of outcome of treatment of idiopathic clubfoot by ponseti technique of manipulation and serial plaster casting

Abstract

Idiopathic clubfoot or congenital talipes equinovarus is the commonest congenital foot deformities having 1 in every 1000 children born worldwide. Around 80% of the cases occur in developing nations. It remains the most difficult to treat. The most widely used treatment is the Ponseti method of manipulation and serial plaster followed by an Achilles tenotomy. This method is effective in 90% of all cases. The objective of this study was to evaluate the outcomes of the Ponseti manipulation and casting method in the management of idiopathic clubfoot. This is a prospective study of 80 feet in 52 children treated by the Ponseti method in the department of Orthopedics, Rajendra Institute of Medical Sciences (RIMS), Ranchi, and Jharkhand. Evaluation of the deformity was done by Pirani score before and after the treatment and the results were assessed. The average number of castings used to correct the deformity was 6.5 times (range: 4 to 12). Tenotomy was performed in 66 (82.5%) of the feet. In all patients, plantigrade foot was achieved. The patients with bilateral clubfeet, higher Pirani score and higher age had inferior final outcome compared to those with unilateral clubfoot, lower Pirani score and lower age. 11 (13.75%) feet had skin excoriation secondary to cast problems and four patients had pain and tenderness at the site of the tenotomy. Recurrence was seen in three cases. 90.38% of parents were completely satisfied with their child’s gait and foot appearance.