OUTCOME OF PONSETI METHOD IN TREATING CONGENITAL IDIOPATHIC CLUBFOOT: FIVE YEARSâ€™ EXPERIENCE AT A TERTIARY HOSPITAL
Â Objective: The earliest non-surgical treatment for the correction of congenital idiopathic talipes equinovarus (CTEV) deformity was described by Ignacio Ponseti. He suggested gentle manipulation and serial applications of casts followed by a period of bracing to maintain the correction. The main objective of this study was to evaluate the result of the Ponseti method with a subjective clinical scoring system using Pirani score, to compare the results with the published literature and to evaluate the effectiveness of foot abduction orthosis (FAO) or ankle-foot orthoses (AFO) in preventing relapse following correction.
Methods: A cross-sectional study which was conducted at the Paediatric Orthopaedic Clinic, Universiti Kebangsaan Malaysia Medical Centre (UKMMC). A minimum of 12 months follow-up casting was observed before the patient was subjected to the subjective clinical scoring system. A total of 25 patients which included 5 right feet, 9 left feet, and 10 bilateral feet with idiopathic clubfeet were treated with Ponseti serial casting. Percutaneous Achilles tendon tenotomy was done for 28 feet (82.35%) to correct the equinus to achieve full correction.
Results: Our results showed that the Ponseti method for treating CTEV was comparable to other published studies. Satisfactory and good results were observed in 97% of cases. A total of 41.18% underwent re-tenotomy of tendon Achilles due to recurrent and persistent equinus.
Conclusion: The treatment of CTEV using Ponseti method will increase the successful correction. Meanwhile, the FAO gave better results for maintenance and prevention of recurrent deformity, compared to the AFO.
2. Ballantyne JA, Macnicol MF. Clubfoot: An overview of the aetiology and treatment. Curr Orthop 2002;16:85-95.
3. Ponseti IV, Smoley EN. Congenital clubfoot: The results of treatment. J Bone Joint Surg (Am) 1963;45:261-75.
4. Pirani S, Outerbridge H, Moran M, Suwatsky B. A Method of Assessing the Virgin Clubfoot. Orlando, FL: POSNA. 1995.
5. Hashim M. Prevalence of postnatal depression and associated risk factors among South Asian mothers living in a newly developing country. Asian J Pharm and Clin Res 2016;9:57-61.
6. Ponseti IV. Congenital Clubfoot: Fundamentals of Treatment. Oxford: Oxford University Press; 1996.
7. Herzenberg JE, Radler C, Bor N. Ponseti versus traditional methods of casting for idiopathic clubfoot. J Pediatr Orthop 2002;22:517-52.
8. Abbas M, Qureshi OA, Jeelani LZ, Azam Q, Khan AQ, Sabir AB. Management of congenital talipes equinovarus by ponseti technique: A clinical study. J Foot Ankle Surg 2008;47:541-45.
9. Laaveg SJ, Ponseti IV. Long-term results of treatment of congenital clubfoot. J Bone Joint Surg (Am) 1980;62:23-31.
10. Hussain N, Khan T, Ahmed A. Complete subcutaneous tenotomy of tendo-achilles in clubfoot patients-a four year follow up. J Surg 2004;1:17-9.
11. Ikeda K. Conservative treatment of idiopathic clubfoot. J Pediatr Orthop 1992;12:217-23.
12. Cooper DM, Dietz FR. Treatment of Idiopathic clubfoot: A thirty year follow-up. J Bone Joint Surg (Am) 1995;77:1477-89.
13. Dobbs MB, Rudzki JR, Purcell DB, Walton T, Porter KR, Grunett CA. Factors predictive of outcome after use of the Ponseti method for the treatment of idiopathic clubfeet. J Bone Joint Surg (Am) 2004;86:22-7.
14. Chen RC, Gordon JE, Luhmann SJ, Schoenecker PL, Dobbs MB. A new dynamic foot abduction orthosis for clubfoot treatment. J Pediatr Orthop 2007;27:522-8.
15. Garg S, Porter K. Improved bracing compliance in children with clubfoot using a dynamic orthosis. J Child Orthop 2009;3:271-6.
16. Sai DT, Prem K. Steenbeek foot abduction brace for clubfoot: Cost effective but is it effective? A prospective study. Asian J Pharm and Clin Res 2017;10:99-102.
17. Dyer PJ, Davis N. The role of the Pirani scoring system in the management of club foot by the Ponseti method. J Bone J Surg (Br) 2006;88:1082-4.
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.