Early Outcome of Ponseti Method for Treatment of Talipes Equinovarus

Abstract

Background: The most widely recognized congenital deformity of musculoskeletal abnormalities at birth is clubfoot, with pain and disability if left untreated. The Ponseti technique has become popular due to its short and long-term success rate published worldwide. Unfortunately, in our country, families have no good interest in it due to several casting and follow-ups, which are essential to the ponseti method. The study's objective was to evaluate our locality's early ponseti method outcome in clubfoot management. Also, to analyze the early recurrence rate and the characteristics of patient and family which predict the recurrence? Methods We studied 50 infants with 77 idiopathic club feet at Erbil teaching hospital between the periods of November 2018 to November 2019. Clubfoot cases were evaluated using the Pirani score at the first presentation, and scores were recorded with a consequent visit, manipulation, and serial casting until correction of deformity was done. Minimal corrective surgery (percutaneous Achilles tenotomy) was performed on the greater part of the idiopathic club feet and preceded with a foot abduction brace; more extensive surgery (posteromedial release) was performed only for resistant cases. Recurrence was analyzed concerning age, gender, parent education, family history, and the family's compliance with bracing- foot abduction brace. Results: 77 feet of 50 babies were managed, 31 were males, and 19 were females. Twenty-seven patients with bilateral clubfeet, the mean Pirani score was (4.623) range (1.5 -6) at presentation. Clubfoot correction was obtained in all but 7 feet (4 cases), about (90, 9%). Among 46 cases (70 feet) the mean cast was 5.49 ranges (3-8) and was required for correction. The normal time for deformity correction was (6.94 weeks, range (of 3-10) for complete deformity correction. Tenotomy was performed on 51 feet (66.2%) with an idiopathic club foot. Early relapse was 14 cases (30, 4%); among them, 12 cases (80%) were due to non-compliant of parents with foot abduction brace. Conclusion: The Ponseti method for clubfoot treatment is safe, successful, and non-invasive. Economical with excellent outcomes, minimize the need for corrective surgery. Relapse is related to noncompliance of the family with bracing.