Year: 2024 | Month: March | Volume: 14 | Issue: 3 | Pages: 223-229
DOI: https://doi.org/10.52403/ijhsr.20240333
Early Predictors of Recurrence and Long-Term Results of Clubfoot Treated by Ponseti Method
Dr Pankaj Kumar Maurya1, Dr Alok Sahu2, Dr Mathew Varghese3, Dr Abhishek Kaushik4
1Specialist in Orthopaedics, District hospital, Bhadohi, Uttar Pradesh India
2Assistant Professor, Department of Orthopaedics, Govt. Medical College and Hospital, Sundargarh, Odisha, India
3 Senior consultant and HOD, Department of Orthopaedics, St. Stephens’s, New Delhi, India
4Senior consultant, Orthopaedics, Accord Super speciality Hospital, Faridabad, India
Corresponding Author: Dr Alok Sahu
ABSTRACT
Background: Congenital Talipes Equino Varus (CTEV) or Clubfoot is one of the most common congenital deformities of foot. Ponseti cast treatment is considered as the standard method for management of idiopathic club foot with better short term as well as long term outcomes reported. It is important to evaluate the results of Ponseti method in treatment of clubfoot and cause for early recurrence along with long term result of this technique.
Material and methods: Retro-prospective observational study regarding short term as well as long term follow up for result of Ponseti treatment method was done during period of September 2015 to June 2017. Short term results and early predictors of recurrence were assessed with data regarding initial Pirani scores, number of casts needed for correction, need of tenotomy, bracing follow up and treatment of recurrence. Long term outcomes were also noted in children older than 5 years after completion of treatment with performance outcomes like sports activity, squatting, shoe comfort, external rotation of foot, dynamic supination and parent satisfaction scores.
Result: A total of 54 patients (80 club feet) were part of the study. Early recurrence (below 5 years) and late recurrence (after 5 years) was observed in 19% and 10% clubfeet respectively. Poor compliance with the foot abduction brace (Steenbeek brace) was thought to be the main cause of early recurrence. While brace bearing more than 5 hours is essential to prevent recurrence; early Achilles tendon tenotomy was noted to favor long term maintenance of correction and prevent recurrence. Long term result shows that clubfoot treated by Ponseti method had 97% supple feet with ability to squat in most of the patients with better clubfoot Disease Specific Instrument (DSI) score, external rotation and ankle dorsiflexion.
Conclusion: Ponseti treatment method is a safe and satisfactory method for congenital idiopathic clubfoot with long term effectiveness. Recurrences mainly occurred due to non-compliance with foot abduction brace. Recurrences can also be treated by same method.
Key words: Recurrence in clubfoot, Congenital tali-pes equinovarus (CTEV), Ponseti Treatment, Idiopathic CTEV, Steenbeek brace compliance