Evaluation of Ponseti method in neglected clubfoot

Abstract

Background:Gentle passive manipulation and casting by the Ponseti method have become the preferred method of treatment of clubfoot presenting at an early age. However, very few studies are available in literature on the use of Ponseti method in older children. We conducted this study to find the efficacy of Ponseti method in treating neglected clubfoot, which is a major disabler of children in developing countries.Materials and Methods:41 clubfeet in 30 patients, presenting after the walking age were evaluated to determine whether the Ponseti method is effective in treating neglected clubfoot. This is a prospective study. Pirani and Dimeglio scoring were done for all the feet before each casting to monitor the correction of deformity. Quantitative variables were expressed as mean ± standard deviation and compared between preoperative and postoperative followup using the paired t-test. Also, the relation between the Pirani and Dimeglio score, and age at presentation with the number of casts required was evaluated using Pearson's correlation coefficient. No improvement in Dimeglio or Ponseti score after 3 successive cast was regarded as failure of conservative management in our study.Results:The mean age at presentation was 3.02 years (range 1.1 - 10.3 years). The mean followup was 2.6 years (range 2–3.9 years). The mean number of casts applied to achieve final correction were 12.8 casts (range 8 - 18 casts). The mean time of immobilization in cast was 3.6 months. The mean Dimeglio score before treatment was 15.9 and after treatment were 2.07. The mean Pirani score was 5.41 before treatment and 0.12 after treatment. All feet (100%) achieved painless plantigrade feet without any extensive soft tissue surgery. 7 feet (17%) recurred in our average followup of 2.6 years.Conclusions:Painless, supple, plantigrade, and cosmetically acceptable feet were achieved in neglected clubfeet without any extensive surgery. A fair trial of conservative Ponseti method should be tried before resorting to extensive soft tissue procedure.

Expanded Age Indication for Ponseti Method for Correction of Congenital Idiopathic Talipes Equinovarus: A Systematic Review

“…Sinha et al (23) conducted a study to determine the efficacy of the Ponseti method in treating neglected CTEV. They evaluated 41 clubfeet in 30 patients who had presented after walking age to determine whether the Ponseti method is effective in treating neglected CTEV.…”

Pedobarographic Analysis following Ponseti Treatment for Unilateral Neglected Congenital Clubfoot

“…Prior to the last cast, a percutaneous tendoachilles tenotomy was performed in feet with persistent equinus. Then, a long leg cast was applied for 3 weeks in patients aged <3 years and for 4 weeks in patients aged >3 years 33 . Subsequently, foot abduction brace, which consisted of a Dennis Browne bar and straight-end shoes, was given to all the patients to prevent recurrence.…”

Causes of Non-Optimal Conservative Treatment of Congenital Clubfoot in Children

“…Не подвергая принципиальному сомнению возможности других методик, сравнительный анализ эффек-тивности метода понсети по отношению как к иным методам консервативного лечения [9,10], так и к хирургическому лечению [11,12] по-зволяют считать его оптимальным, а остальные методики, даже учитывая их относительную эффективность, на сегодняшний день относить к неоптимальным. Существенную роль метод понсети играет в лечении пациентов с реци-дивами деформаций, а также неэффективным предшествовавшим лечением [13][14][15].…”