MANAGEMENT OF CONGENITAL TALIPES EQUINOVARUS BY THE PONSETI METHOD -- SHORT--TERM AND INTERMEDIATE EFFECTIVENESS OF THE TECHNIQUE AND FACTORS AFFECTING OUTCOME

Management of Congenital Talipes Equinovarus

Abstract

Objective: To evaluate the effectiveness of the Ponseti method of clubfoot management in neonates and infants and to see which factors affect outcome.
Study Design: Retrospective study.
Place and Duration of Study: Department of Paediatric surgery, Military Hospital, Rawalpindi, from October 2012 to September 2014.
Material and Methods: The Ponseti method for the management of congenital talipes equinovarus was applied in children of 7 days to 6 months age. While those with complex neurological problems, pathological clubfeet, syndromic clubfeet and older than 6 months at the time of presentation were excluded from the study. Assessment was done at presentation, at the removal of the last plaster cast and after one-year use of the foot abduction splint.
Results: A total of 124 clubfeet of 89 children, including 63 males (70.78%) and 26 females (43.82%) were treated as outdoor cases. Eighteen feet (14.51%) were of rigid (atypical) type whilst 106 (85.5%) were of flexible (typical) type. Bilateral involvement was seen in 35(37.31%) children. The mean pretreatment Pirani score was 5.4 and the mean number of plaster casts required was 5.8. The mean Pirani score at 1-year follow-up was 0.5 with successful outcome in 82.3 % of all cases (96.9 % of neonates). Poor compliance with the use of the foot abduction splint adversely affected outcomes.
Conclusion: The Ponseti method of treatment of congenital clubfeet is safe and easy to learn with effective and reproducible results. Early start of treatment and compliance with the use of the foot abduction splint during the maintenance phase are crucial to successful outcome.