Changes in the Foot After Two Years of Deformity Correction in Neglected Clubfeet Treated With Modified Ponseti Technique

Abstract

IntroductionNeglected clubfoot comprises clubfoot deformities with late presentation and weight-bearing on the affected foot. These deformities are stiff and need an aggressive approach for cast-based management. The modified versions of the Ponseti technique have been found effective in treating these deformities. However, these techniques' long-term outcomes in neglected clubfoot and related correction maintenance with time progression have not been investigated. The current study aims to analyze the changes in deformity correction after a minimum of two years of follow-up in neglected clubfeet treated with a modified Ponseti method of corrective casting. MethodsWe retrospectively analyzed the clinical records of 25 patients with 38 neglected clubfeet with a mean follow-up of 37.9±4.1 months after the initial correction of the deformity. These patients were managed with a modified Ponseti technique. The modified technique incorporated simultaneous deformity manipulation before equinus correction and additional dorsiflexion manipulation after two weeks of tendo-achilles tenotomy. The Pirani and Dimeglio scores and individual deformity corrections at the final follow-up were compared with those at final cast removal. ResultsNo significant differences were observed between the initial and the final follow-up Pirani and Dimeglio scores. Concerning the deformity correction parameters, there was a significant loss in heel varus and foot abduction correction. However, the change in these parameters was small (less than 3 degrees). ConclusionThe neglected clubfoot deformity can be satisfactorily corrected with an aggressive Ponseti based corrective manipulation and casting at a low relapse rate. However, minor loss of deformity correction is noticed after two years of treatment which is not reflected in clinical scores. Therefore, a strict long-term follow-up and careful deformity assessment are required to predict the recurrence in these cases.

Application of pedobarographic analysis in neglected congenital clubfoot patients following Ponseti treatment for recurrence prediction

“…An a priori power analysis (α = 0.05, β = 0.20) was conducted using GPower 3.0© software to determine the sample size. Based on an unpublished pilot study and a review of previous research [ [13] , [14] , [15] ], a sample size of 25 was initially estimated. Accounting for a potential dropout rate of 15%, a minimum of 30 participants needs to be included in the present study.…”

“…The treatment outcomes for NCCF have traditionally been assessed primarily through clinical and functional examinations, employing scales and questionnaires [ 13 , 14 ] such as Pirani and Dimeglio scores. However, these methods pose challenges in achieving accurate and quantitative evaluation and are susceptible to subjective influences from examiners.…”

Comparison of outcome of Ponseti method with traditional clubfoot treatment in children up to five years of age at tertiary care hospital

“…Earlier on, most of the children needed surgical interventions; however, from the last twenty years, the Ponseti treatment is perceived as a standard treatment of clubfoot across the world. [1][2][3] Traditionally, clubfoot is treated clinically but physiotherapy has also been proven effective even in non-idiopathic and complicated cases. 4 The survey data suggests the drop in conduction of extensive surgeries for treating clubfoot from 70% in 1996 to only about 10% in 2006 in the USA.…”