Evaluation of the utility of the Ponseti method of correction of clubfoot deformity in a developing nation

Abstract

Clubfoot is the commonest congenital deformity in babies. More than 100,000 babies are born worldwide each year with congenital clubfoot. Around 80% of the cases occur in developing nations. We treated 154 feet [mean Pirani score (total) 5.57] in 96 children (78 males, 18 females) by the Ponseti method from January 2003 to December 2005. A prospective follow-up for a mean duration of 19.5 months (range 6-32 months) was undertaken. After six months of treatment the Pirani score was reduced to zero for all patients. The results show that corrective surgery, sometimes multiple, can be avoided in most cases which are usually associated with the development of a stiff, painful foot. Low socio-economic status and illiteracy prevailing in developing nations increases the prevalence of neglected clubfoot that is still harder to correct. Integration into various programs and proper use of available resources can decrease neglected clubfoot and improve chances of successful and timely correction of deformity. Bracing constitutes an important part of treatment and proper motivation and education of the parents mitigates the chances of losing correction. The Ponseti method of correcting clubfoot is especially important in developing countries, where operative facilities are not available in the remote areas and well-trained physicians and personnel can manage the cases effectively with cast treatment only.

Ponseti Method for Untreated Idiopathic Clubfeet in Nepalese Patients From 1 to 6 Years of Age

“…With the perception that the treatment of idiopathic clubfoot by extensive soft tissue release is often complicated by stiffness, recurrence, and the need for additional procedures, many treatment centers have adopted the minimally invasive Ponseti method, which has achieved excellent results in both economically developed [1-4, 6-8, 10, 11, 13, 14, 16, 18, 19, 21-26] and underdeveloped regions [9,12,17,28]. Although the majority of patients in these studies have been treated in infancy, recent evidence suggests the method may be appropriate for patients of walking age [9,17,28], and the upper age limit remains to be established.…”

The Role of Ultrasound in Clubfoot Treatment: Correlation with the Pirani Score and Assessment of the Ponseti Method

“…However, many complications were encountered with operative treatment such as forefoot adduction (range, 17%-81.1%), cavus (range, 5.9%-45.5%), overcorrection (range, 3.8%-22.2%), hindfoot equinus or varus (range, 7.2%-41.5%), and avascular necrosis of the talus (range, 3.2%-14.3%) [2,25,33]. Consequently, some centers around the world [1,8,12,19,21,22] revived the Ponseti method with deformity correction being maintained short-and long-term. The importance of using postcasting abduction splints to maintain correction was stressed by Ponseti [28] and others [1,8,12,19,21,22].…”

Preliminary evaluation of implementing the Ponseti method for correction of clubfoot in Vietnam

“…Of these, 24 (80%) indicated that they did need more training and made comments relating to which aspects of training was needed, including: follow up [1], more Ponseti, especially practical [4], anterior tibial tendon transfer [1], casting and manipulation [10], tenotomy [10], FAB [1], surgery [1], older cases [1], and updates [1]. Figure 4 shows the responses of the trainees to the parent's understanding and acceptance of the Ponseti method.…”