Management of idiopathic clubfoot by Ponseti’s technique

Abstract

Background and objective: Idiopathic Congenital Talipes Equinovarus (CTEV) is a complex deformity that is difficult to correct. The treatment of clubfoot is controversial and continues to be one of the biggest challenges in paediatric orthopaedics. Most orthopaedicians agree that the initial treatment should be non-surgical and should be started soon after birth. We aimed to study a short term follow up of 30 patients treated by the Ponseti method at the department of Orthopaedics, Mahatma Gandhi Medical College & Research Institute, Pondicherry to assess the efficacy of Ponseti’s technique for the treatment of CTEV. Methods: 30 patients were selected from the Out-Patient section of the Department of Orthopaedics and Traumatology, M.G.M.C & R.I, Pondicherry for correction of idiopathic CTEV using the Ponseti technique from June 2011 to March 2013. Children included in the study were assessed for the severity of the deformity using the Pirani severity scoring system and clinical photographs were obtained. Casting of the foot was started by the technique described by Ponseti. Before cast placement every week, the foot deformity severity was assessed using the Pirani scoring system. These patients were followed up in a prospective manner for a period of minimum of six months. Results: At 6 months’ follow-up, Ponseti’s technique gave us 64.86% excellent results, 29.72% good results and a 5.4% poor results. 43.24 % required pecutaneous tenotomy, while 56.76% did not require tenotomy. There was an incidence of 8.1% for postero-medial soft tissue release. Interpretation and conclusion: The Ponseti method is a safe and cost effective treatment modality for congenital idiopathic clubfoot which gives excellent results, and radically decreases the need for extensive corrective surgery.