Title: Ponseti’s Method: Is It Effective in Conservative Management of Neglected Congenital Talipes Equino Varus
Authors: Dr Arun Kumar Seshadrinath N, Dr Sabarisree Manikantan
DOI: https://dx.doi.org/10.18535/jmscr/v5i4.220
Abstract
Background: Clubfoot should be ideally corrected in infancy. Developing nations have inadequate medical and surgical resources. The cost of managing clubfoot surgically and the associated crippling deformities in later life makes conservative management a coveted means in developing. There are no guidelines in management of neglected clubfoot and the upper limit for age is yet to be determined.
Aim: To evaluate the effectiveness of Ponseti’s method of conservative Management of Congenital Talipes Equino Varus in neglected clubfoot.
Settings and Design: This Prospective study was executed in the out-patient department & was conducted as a non-randomized prospective interventional analysis.
Methods and Material: All children in the weight bearing age group between 8 months to 16 years having Idiopathic Congenital Talipes Equino Varus, both unilateral and bilateral were included in the study. Altogether there were 37 patients amounting to a total of 61 clubfeet. They were all managed by Ponseti's method of casting. All the patients were compulsorily evaluated for 1.5 years and the evaluation was continued to the maximum possible until the tenure of the study. Children with clubfeet above the age of 16 years and below the age of weight bearing, those with teratologic clubfoot, those with syndromic associations and Recurrent or relapsed clubfeet consequent to failed surgical treatment were excluded from the study. Their pre-treatment Pirani score was noted and the scoring was done on every subsequent visits. The end point was a score <= 1.5 with the feet having 300-400 of external rotation and 150 of dorsiflexion.
Statistical analysis used: The means of Pre-treatment Pirani score was compared with the mean of Post-treatment Pirani score using paired t test. Linear Regression and correlation was used to analyse the number of casts required based on the age of the patient and Pre-treatment Pirani score
Results: 44 clubfeet were able to achieve the end point with Ponseti’s protocol. There was a significant (p<0.001) change in the mean pre-treatment and post treatment Pirani score. There was a strong correlation between the severity scoring and the number of casts needed and a weaker correlation between the age and the number of casts needed. The overall complications included equinus relapse, rigid equinus, skin erythema, knee rigidity and anaesthetic complication.
Conclusions: Ponseti’s method is definitely an effective method in neglected clubfoot deformity. Even in stiff clubfeet it has its use as initial management. We were able to correct 72% of the clubfeet and in the rest, Ponseti’s method helped in reducing the amount of deformity.
Keywords-Neglected, Resistant and complex clubfoot; plantigrade foot, prolonged casting, Pirani’s score.
