We have modified the Ponseti casting technique by using a below-knee Softcast instead of an above-knee plaster of Paris cast. Treatment was initiated as soon as possible after birth and the Pirani score was recorded at each visit. Following the manipulation techniques of Ponseti, a below-knee Softcast was applied directly over a stockinette for a snug fit and particular attention was paid to creating a deep groove above the heel to prevent slippage. If necessary, a percutaneous Achilles tenotomy was performed and casting continued until the child was fitted with Denis Browne abduction boots.Between April 2003 and May 2007 we treated 51 consecutive babies with 80 idiopathic club feet with a mean age at presentation of 4.5 weeks (4 days to 62 weeks). The initial mean Pirani score was 5.5 (3 to 6). It took a mean of 8.5 weeks (4 to 53) of weekly manipulation and casting to reach the stage of percutaneous Achilles tenotomy. A total of 20 feet (25%) did not require a tenotomy and for the 60 that did, the mean Pirani score at time of operation was 2.5 (0.5 to 3). Denis Browne boots were applied at a mean of 10 weeks (4 to 56) after presentation. The mean time from tenotomy to boots was 3.3 weeks (2 to 10). We experienced one case of cast-slippage during a period of non-attendance, which prolonged the casting process. One case of prolonged casting required repeated tenotomy, and three feet required repeated tenotomy and casting after relapsing while in Denis Browne boots.We believe the use of a below-knee Softcast in conjunction with Ponseti manipulation techniques shows promising initial results which are comparable to those using above-knee plaster of Paris casts.The Ponseti technique 1 is increasingly popular in the treatment of congenital talipes equinovarus. However, his method of serial manipulation and above-knee plaster of Paris casting causes some practical difficulties. Above-knee casts can make perineal hygiene more difficult, especially in bilateral cases and the removal of casts can be distressing for the child and parents.2 The theoretical disadvantages of aboveknee casts include the immobilisation of rapidly growing bones and joints. 3,4

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Background: Protein energy malnutrition is the most widely prevalent form of malnutrition among under-five children. Factors responsible for malnutrition in India comprise of low birth weight, maternal health problems, delay in introduction of complementary feeds, faulty child care and other poor environmental conditions. This study aims to evaluate the health status of mothers of severe acute malnutrition (SAM) children admitted in three NRC’s of Bhopal.Methods: A cross-sectional record based study was done on mothers of 255 children up to 5 year of age who were admitted with SAM in the three NRC of Bhopal district. Details were filled in a questionnaire. The body mass index (BMI) was calculated and graded according to the WHO classification.Results: The mean age of study participants was 24.8 years, mean BMI was 18.5, mean Hb was 10.4 g/dl. According to the BMI, 147 (57.7%) of the mothers were underweight, out of them 43 (16.8%) were severely thin. Anemia was present in 90% mothers, out of which 80% were moderately anemic and 11 (4.3%) was severely anemic, anemia and BMI of mothers have a significant correlation. At the time of the study, 65 (26%) mothers had more than two children and 113 mothers had two children.Conclusions: The health status of mothers indicates that they are undernourished and anemic with lower parity and age. It is therefore recommended that during the 14-21 day stay of SAM child maternal nutrition should be emphasized upon along with counselling sessions.

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