Outcome of Ponseti method of manipulation and casting for idiopathic clubfoot at Nishtar Medical University Hospital Multan.
Keywords:Club foot, Congenital Talipes Equinovarus, Pirani score, Ponesti.
Objective: To determine the outcome of Ponseti technique of manipulation and serial casting for idiopathic clubfoot in terms of correction achieved as per improvement in Pirani scoring.
Methods: This descriptive study was conducted in Orthopaedic department Nishtar Medical University Hospital Multan from 25th January 2019 to 25th January 2021. All children of below one year age with idiopathic clubfoot fulfilling the inclusion criteria were treated with Ponseti method of manipulation and serial casting on weekly basis. Pirani score was used to assess foot deformity before and after casting and interpreted as excellent outcome(0 and 1 score),good outcome(1.5 and 2.5 score) and poor outcome(?3 score).The pre and post casting Pirani score was compared and P value was calculated with paired t-test. P value< 0.05 was considered significant.
Results: In this study 100 children with idiopathic club feet were enrolled but 90 children completed the study. Bilateral club feet was present in 45(50%) children and unilateral in 45(50%) children. The total feet treated were 135. The mean age was 45.31±61.87 days. Male children were 53 (58.9%) and female 37 (41.1%). The average number of casts were 5.37±1.80. Tendo Achilles tenotomy was carried out in 73 (81.1%) children. The mean pre casting Pirani score of the right foot was 4.88±1 and post casting 0.13±0.44(p < 0.05) The mean pre casting Pirani score of the left foot was 5.02±1.19 and improvement was noticed with post casting Pirani score of 0.8±0.20(p<0.05).Overall excellent outcome was documented in 110(81.48%) feet and good outcome in 25(18.51%) feet.
Conclusion: The Ponseti technique of manipulation and casting was very effective in correcting the club foot deformity as indicated by significant improvement in Pirani scoring and excellent outcome in majority of our patients.
Gavin Bowyer MU. The ankle and foot. In: Ashley Blom DW, Michael R, Whitehouse, editor. System of Orthopaedics and Trauma. 10th ed. new york: CRC Press; 2018. p. 614-617.
Kelly DM. congenital anomalies of the lower extremity. In: Frederick M. Azar JHB, S. Terry Canale, editor. Campbell's Operative Orthopaedics. 13th ed. Philadelphia: Elsevier; 2017. p. 1031-1041.
Parker SE, Mai CT, Strickland MJ, Olney RS, Rickard R, Marengo L, Wang Y, Hashmi SS, Meyer RE; National Birth Defects Prevention Network. Multistate study of the epidemiology of clubfoot. Birth Defects Res A Clin Mol Teratol. 2009 ;85(11):897-904.
Bhatti A, Bhatti MY, Ali MF. Association of consanguinity, ethnicity and addiction with clubfoot in Pakistan. J Pak Orthop Assoc. 2015;27(3):101–104.
Hussain H, Burfat AM, Samad L, Jawed F, Chinoy MA, Khan MA. Cost-effectiveness of the Ponseti method for treatment of clubfoot in Pakistan. World J Surg. 2014;38(9):2217–2222.
Wang H, Barisic I, Loane M, Addor MC, Bailey LM, Gatt M, et al. Congenital clubfoot in Europe: A population-based study. Am J Med Genet A. 2019 ;179(4):595-601.
Pavone V, Chisari E, Vescio A, Lucenti L, Sessa G, Testa G. The etiology of idiopathic congenital talipes equinovarus: a systematic review. J Orthop Surg Res. 2018;13(1):206-215.
Loof E, Andriesse H, Broström EW, André M, Bölte S. Neurodevelopmental difficulties in children with idiopathic clubfoot. Dev Med Child Neurol. 2019 ;61(1):98-104.
Dietz FR, Noonan K. Treatment of Clubfoot Using the Ponseti Method. JBJS Essent Surg Tech. 2016 10;6(3):e28. doi: 10.2106/JBJS.ST.14.00112.
Qureshi AR, Warriach SB. Evaluation of Ponseti method for management of idiopathic clubfoot in toddlers. Pak J Med Sci. 2013;7:730-732.
Zia MI, Javaid MZ, Rehman OU. Efficacy of Ponseti Manipualtion and Casting in Management of Idiopathic Clubfoot: Early Results. J Pak Orthop Assoc. 2013;25(2):1-4.
Barik S, Nazeer M, Mani BT. Accelerated Ponseti technique: efficacy in the management of CTEV. Eur J Orthop Surg Traumatol. 2019;29(4):919-924.
Pirani S, Outerbridge HK, Sawatzky B, Stothers K. A reliable method of clinically evaluating a virgin clubfoot evaluation. 21st SICOT Congress. Sydney, Australia: 1999.
Pirani S, Zeznik L, Hodges D, Magnetic resonance imaging study of the congenital clubfoot treated with the Ponseti method. J Pediatr Orthop.2001;21(6):719-726.
Ostadal M, Chomiak J, Dungl P, Frydrychova M, Burian M Comparison of the short-term and long-term results of the Ponseti method in the treatment of idiopathic pes equinovarus. Int Orthop.2013;37(9):1821-1825.
Pavone V, Testa G, Alberghina F, Lucenti L, Sessa G. Effectiveness of Ponseti Method for the Treatment of Congenital Talipes Equinovarus: Personal Experience. Pediat Therapeut.2015; 5: 260. doi:10.4172/2161-0665.1000260
Ponseti IV. Treatment of congenital club foot.J Bone Joint Surg Am. 1992;74(3):448-454.
Faldini C, Traina F, Nanni M, Sanzarello I,Borghi R ,Perna F . Congenital idiopathic talipes equinovarus before and after walking age: observations and strategy of treatment from a series of 88 cases. J Orthopaed Traumatol.2016;17:81–87.
Kumar S, Singh PP, Singh MK, Kumar Y, Verma S, Kumar H. Outcomes of Ponseti technique in management of idiopathic clubfoot in Infants - A short term study of Ninety feet in rural India.JBJD.2020;35:9-13.
Malhotra R, Mohapatra A, Arora G, Choudhury P, Joshi H, Patel P. Ponseti Technique for the Management of Congenital Talipes Equinovarus in a Rural Set-Up in India: Experience of 356 Patients. Children. 2018;5(4):49-55.
Sakale H, Agrawal A, Singh A, Sahoo B, Jain A. Treatment of idiopathic clubfoot by Ponseti method. J Orthop Traumatol Rehab.2017;9:25-29.
Ahmad I, Mehmood AU, Ali KW, Jameel HU. Cross Sectional Study of Clinical Profile and Treatment of Clubfoot by Ponseti Method among Infants at a Tertiary Care Hospital. Health Sci J.2020;14(4):726-732.
Saetersdal C, Fevang J, Fosse L, Engesaeter L. Good results with the Ponseti method: A multicenter study of 162 clubfeet followed for 2–5 years. Acta Orthop. 2012;83:288-293.
Smythe T, Chandramohan D, Bruce J, Kuper H, Lavy C, Foster A. Results of clubfoot treatment after manipulation and casting using the Ponseti method: experience in Harare, Zimbabwe. Tropical Medicine and International Health. 2016;21(10):311–1318.
Jaqueto PA, Martins GS, Mennucc FS. Functional and clinical results achieved in congenital clubfoot patients treated by Ponseti’s technique. Revista Brasileira de Ortopedia(English Edition).2016;51(6):657–661.
Changulani M, Garg NK, Rajagopal TS, Bass A, Nayagam SN, Sampath J, et al. Treatment of idiopathic club foot using the Ponseti method. Initial experience. J. Bone Joint Surg. Br. 2006;88:1385–1387.
Lehman W, Mohaideen A, Madan S, Scher D, Van Bosse H, Iannacone M, et al. A method for the early evaluation of the Ponseti (Iowa) technique for the treatment of idiopathic clubfoot. J Pediatr Orthop. B.2003;12:133–140.
Pavone V, Testa G, Costarella L, Pavone P, Sessa G. Congenital idiopathic talipes equinovarus: An evaluation in infants treated by the Ponseti method. Eur Rev Me. Pharmaco. Sci. 2013;17:2675–2679.