Efficacy Of Ponseti Method In Management Of Club Foot

Abstract

Objective: To determine the efficacy of ponseti method in the treatment of club foot.
Material and Methods: This descriptive case series was conducted at Department of
Orthopaedic Surgery, Services Institute of Medical Science (SIMS) / Services Hospital Lahore.
Sample size of 100 was calculated with 95% confidence using non probability purposive sampling
technique. children of age 6 month to 1 year with club foot of either sex were included. while those
with any associated congenital anomaly were excluded and children with idiopathic club foot
having skin disease and pressure sore due to POP cast were also excluded. All children had six
casts at weekly interval by ponseti's technique. Prior to the fifth cast percutaneous Achilles
tenotomy was done under local anesthesia if dorsiflexion was not possible beyond neutral.
Following the removal of the last cast all the feet are placed in a Foot Abduction Arthosis (AFO).
Sixth months after the completion of plaster treatment all feet were assessed by Pirani score.
Results: A total of 100 children were included in the study. The mean age was 5.78 ± 3.21
months. Majority of the patients were between 0-9 months of age i.e. 63% (n=63), and between
10-12 months 37% (n =37). Male to Female ratio in our study was 1.127:1. Percutaneous Achillies
tonotomy was done in 82% of cases. Pirani score six months after cast treatment was calculated
which shows 88% (n=88) Children had good results and 12 % (n=12) didn't have effective results.
Efficacy of Ponseti method in the treatment of club foot reveals Pirani score <1 in 88% (n =88)
while >1 in 12% (n=12). Stratification for efficacy of Ponseti method with regards to age before
treatment reveals that out of 88 cases 68.18% (n =60) were between 0-9 months of age and
31.82% (n=28) were between 10-12 months of age. Stratification for efficacy of Ponseti method
with regards to initial Pirani score before treatment reveals that out of 88 cases 88.64% (n=78)
had < 4 and 11.36%(n =10) had >4 Pirani score.
Conclusion: We concluded that Ponseti method is highly effective for the management of club
foot in children up to 12 months of age and need for extensive corrective surgery is greatly
reduced. We recommend the Ponseti method as standard therapy in clubfoot management