DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20190503

Assessment of Ponseti technique of manipulation and serial casting in idiopathic clubfoot

Asif Hussain Khazi Syed, Kiran Kumar Koppolu Kanthi, Yakub Baroothu, Lalith Mohan Chodavarapu

Abstract


Background: Congenital talipes equinovarus is one of the commonest congenital foot deformities. Ponseti technique of treatment of clubfoot has gained popularity in the last few decades. Feet treated by Ponseti technique are supple, flexible and pain free. We have treated congenital idiopathic clubfoot with Ponseti technique at our institute and present our results.

Methods: Forty eight feet in thirty children with clubfoot were treated by Ponseti technique in our institute. The study was conducted from December 2013 to December 2015. Parents were counselled regarding treatment protocol and maintenance with bracing was closely monitored. Each child was followed up for a minimum of six months. Pirani score was used to objectively document progress of treatment.

Results: The average number of casts required for complete correction was 6.6. 38% feet required tendoachilles tenotomy. Higher the initial Pirani score, more number of casts were required to achieve full correction. Number of casts needed for complete correction did not correlate to time of presentation.

Conclusions: Ponseti method is very effective in correcting congenital idiopathic clubfoot deformity. It’s easy to learn, is inexpensive and can completely correct the deformity. In developing nations, well trained Orthopaedic surgeons can treat these children effectively and decrease disabled population.

 


Keywords


Clubfoot, Ponseti, Pirani score

Full Text:

PDF

References


Ponseti IV. In: Congenital clubfoot: fundamentals of treatment. Oxford: Oxford University Press; 1996.

Wynne-Davies R. Family studies and the cause of congenital club foot. Talipes equinovarus, talipes calcaneo-valgus and metatarsus varus. J Bone Joint Surg Br. 1964;46(3):445-63.

Lochmiller C, Johnston D, Scott A, Risman M, Hecht JT. Genetic epidemiology study of idiopathic talipes equinovarus. Am J Med Genet. 1998;79(2):90-6.

Barker SL, Macnicol MF. Seasonal distribution of idiopathic congenital talipes equinovarus in Scotland. J Pediatr Orthop B. 2002;11(2):129-33.

Chueire AJFG, Filho GC, Kobayashi OY, Carrenho L. Treatment of congenital clubfoot using Ponseti method. Revista Brasileira de Ortopedia. 2016;51(3):313-8.

Kite JH. Non operative treatment of congenital clubfeet: A review of one hundred cases. South Med J. 1930;23:337.

Kite JH. Principles involved in the congenital clubfoot. J Bone Joint Surg. 1939;21:595-606.

Karski T, Wosko I. Experience in the conservative treatment of congenital clubfoot in newborns and infants. J Pediatr Orthop. 1989;9(2):134-6.

Aronson J, Puskarich CL. Deformity and disability from treated clubfoot. J Pediatr Orthop. 1990;10(1):109-19.

Turco VJ. Surgical correction of the resistant club foot. One-stage posteromedial release with internal fixation: a preliminary report. J Bone Joint Surg Am. 1971;53(3):477-97.

Turco VJ. Resistant congenital club foot - one-stage posteromedial release with internal fixation. A follow-up report of a fifteen-year experience. J Bone Joint Surg Am. 1979;61(6):805-14.

McKay DW. New concept of and approach to clubfoot treatment: Section III - evaluation and results. J Pediatr Orthop. 1983;3(2):141-8.

Hudson I, Catterall A. Posterolateral release for resistant club foot. J Bone Joint Surg Br. 1994;76(2):281-4.

Simons GW. Complete subtalar release in club feet. Part II - Comparison with less extensive procedures. J Bone Joint Surg Am. 1985;67(7):1056-65.

Carroll NC. Surgical technique for talipes equinovarus. Oper Tech Orthop. 1993;3(2):115-20.

Ippolito E, Farsetti P, Caterini R, Tudisco C. Long-term comparative results in patients with congenital clubfoot treated with two different protocols. J Bone Joint Surg Am. 2003;85(7):1286-94.

Dobbs MB, Nunley R, Schoenecker PL. Long-term follow-up of patients with clubfeet treated with extensive soft-tissue release. J Bone Joint Surg Am. 2006;88(5):986-96.

Hutchins PM, Foster BK, Paterson DC, Cole EA. Long-term results of early surgical release in club feet. J Bone Joint Surg Br. 1985;67(5):791-9.

Dobbs MB, Gurnett CA. Update on clubfoot: etiology and treatment. Clin Orthop Relat Res. 2009;467(5):1146–53.

Bensahel H, Csukonyi Z, Desgrippes Y, Chaumien JP. Surgery in residual clubfoot: one-stage medioposterior release "a la carte". J Pediatr Orthop. 1987;7(2):145-8.

Ponseti IV, Smoley EN.Congenital clubfoot: the results of treatment. J Bone Joint Surg Am. 1963;45(2):2261–75.

Ponseti IV.Treatment of congenital clubfoot. J Bone Joint Surg Am. 1992;74(3):448–54.

Ponseti IV.Correction of the talar neck angle in congenital clubfoot with sequential manipulation and casting. Iowa Orthop J. 1998;18:74–5.

Ponseti IV.Clubfoot management. J Pediatr Orthop, 2000;20(6):699–700.

Ponseti IV. The Ponseti technique for correction of congenital clubfoot. J Bone Joint Surg Am. 2002;84(10):1889-91.

Colburn M, Williams M. Evaluation of the treatment of idiopathic clubfoot by using the Ponseti method. J Foot Ankle Surg. 2003;42(5):259–67.

Dobbs MB, Rudzki JR, Purcell DB, Walton T, Porter KR, Gurnett CA. Factors predictive of outcome after use of the Ponseti method for the treatment of idiopathic clubfeet. J Bone Jt Surg Am. 2004;86:22–7.

Changulani M, Garg NK, Rajagopal TS, Bass A, Nayagam SN, Sampath J, et al. Treatment of idiopathic club foot using the Ponseti method. Initial experience. J Bone Joint Surg Br. 2006;88(10):1385-7.

Bor N, Coplan JA, Herzenberb JE. Ponseti treatment of idiopathic clubfoot: minimum 5-year followup. Clin Orthop Relat Res. 2009;467(5):1263–70.

Matuszewski L, Gil L, Karski J. Early results of treatment for congenital clubfoot using the Ponseti method. Eur J Orthop Surg Traumatol. 2012;22:403–6.