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J Liaquat Uni Med Health Sci. 2011; 10(2): 71-74


Clubfoot Treatment by Ponseti Method

Asadullah Makhdoom, Muhammad Ayub Laghari, Muhammad Khan Pahore, Pir Abdul Latif Qureshi, Irshad Ahmed Bhutto, Khaleeque Ahmed Siddiqui.

Abstract
OBJECTIVE: To document the outcome of Ponseti method in the treatment of clubfoot.
STUDY DESIGN: Observational-descriptive study.
Place and Duration: Department of Orthopedic Surgery and Traumatology, Liaquat University of Medical and Health Sciences (LUMHS) Jamshoro, Sindh Pakistan, from January 2007 to December 2010 (4-years).
METHODOLOGY: Clubfeet were treated by Ponseti technique. Pirani score was recorded for all subjects at the time of presentation and a foot was considered fully corrected when scored 0-0.5. Immediately after the removal of last cast, foot abduction braces were used. Follow-up pattern was at two weeks, at three months, then at four month interval up to 3-years age, then at six month interval up to 4-years age, and then once a year. Any relapses were treated accordingly. Tenotomy was repeated in equines, whereas castings were repeated in adduction of forefoot, intoeing and cavus.
RESULTS: During the study period 49 children presented 71 clubfeet with 27 (55.1%) unilateral and 22 (44.9%) bilateral cases. The mean Pirani score at the time of presentation was 5.44. Majority (63.38%) feet required casting up to 5-weeks and in 69.01% feet complete correction was acquired by five casts (mean 5.6 casts). Achilles tenotomy was performed in 65 (91.55%) feet. Pirani score of 0-0.5 was achieved in 69 (97.18%) cases within 1-year follow-up. Thirteen (18.31%) cases of relapse were reported. Among these, 2 (2.82%) cases of equinus underwent repeat tenotomy; whereas 7 (9.86%) cases of adduction, 3 (4.23%) cases of cavus and 1 (1.41%) case of intoeing were treated by repeat casting.
CONCLUSION: Ponseti method can be used in our setup with excellent correction of clubfoot deformity, and surgical complications can be minimize by this technique.

Key words: Clubfoot; Congenital talipes equinovarus; Ponseti; Pirani; Relapse; Achilles tenotomy; Adduction; Cavus; Intoeing.



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