The authors would like to thank the support staff involved in the study. In addition, thanks are due to the superintendent of the primary health centre and to the Dean of Dnyandeo Yashwantrao Patil University. This project was funded by Dnyandeo Yashwantrao Patil research committee project no. National Center for Biotechnology Information , U. Journal List Children Basel v. Children Basel.
Published online Apr Author information Article notes Copyright and License information Disclaimer. Received Dec 22; Accepted Apr 3. Keywords: congenital talipes equinovarus, clubfoot, Ponseti, Pirani score, rural set-up, India. Introduction Congenital talipes equinovarus CTEV , also known as clubfoot, is a complex, congenital deformity of the foot.
Clubfoot: Ponseti Management
Materials and Methods 2. Study Area This was a prospective clinical study done in the orthopaedic and paediatrics department of a rural primary health centre in the state of Maharashtra, India, between and Evaluation of Final Outcome The severity of deformity and the functional outcome was graded according to the Pirani scoring system both at the beginning and at the end of the treatment.
Open in a separate window. Figure 1. Figure 2. Figure 3. Figure 4. Figure 5. Figure 6.
Figure 7. Figure 8. Results 3. Age In our study, there were males and females. Table 1 Age distribution of patients. Laterality Among the cases, cases Consaguinity and Family History We found that cases Pirani Score In our series, the mean initial Pirani score at the time of presentation of cases was 5.
Figure 9. Table 2 Pirani score distribution pre- and post-treatment. SD: Standard deviation. Number of Casts The mean total number of casts required to correct the deformity was found to be 6. Table 3 Age distribution of casts. Complications In our series, a few minor complications were encountered during the casting procedure which included skin abrasions, cast saw injuries, cast loosening and cast breakage Figure 10 and Figure Figure Final Outcome Based on the Pirani score, the final functional outcomes were graded as excellent, good and poor and consisted of , 41 and 40 patients, respectively Table 4.
Table 4 Distribution of final outcome.
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Comparison of Cost of Treatment Total charges that we incurred for each patient were 71 USD, which was comparatively less than for the Turcos procedure charges of 96 USD and hence very affordable for each of the patients Table 5. Table 5 Distribution of cost. Discussion CTEV is one of the commonest congenital deformities. Demographic and Etiological Variables In our study, the average age of presentation was 4. Table 6 Comparison of laterality with other studies. Pirani Score The above findings signify that as the age of presentation increases the severity of the deformity increases.
Table 7 Comparison of tenotomy with other studies. Table 8 Comparison of casts applied with other studies. Studies Casts Lehman et al. Final Functional Outcome We used the Pirani score as a functional tool for the assessment of the functional outcome. Conclusions Clubfoot or CTEV can be successfully graded by the Pirani score which is reproducible and does not show any inter-observer variation.
Acknowledgments The authors would like to thank the support staff involved in the study. Author Contributions A. Conflicts of Interest The authors have no conflicts of interest. References 1. De Hoedt A. Staheli L. Clubfoot: Ponseti Management. Globalclubfoot India Global Clubfoot Initiative. Africa Clubfoot Training Project.
University of Oxford; Oxford, UK: Kelly D. Congenital anomalies of the lower extremity. In: Canale S. Morcuende J. Radical reduction in the rate of extensive corrective surgery for clubfoot using the Ponseti method. Ponseti I.
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- The Ponseti Method for Clubfoot Correction: An Overview for Parents!
Congenital clubfoot: The results of treatment. Bone Joint Surg. Khan M. Significance of Pirani score at bracing-implications for recognizing a corrected clubfoot. Iowa Orthop.
Clubfoot: Ponseti Management - Global HELP
Dobbs M. Long term follow up of patients with clubfoot treated with extensive soft tissue releases. Cosma D. Comparative results of the conservative treatment in clubfoot by two different protocols.
Faizan M. Management of idiopathic clubfoot by Ponseti technique in children presenting after one year of age. Foot Ankle Surg. One child with bilateral clubfeet developed an allergy to the splints and was out of them without information and ended up with a fair result Figure The child needed to be subjected to manipulations and castings again, till correction was achieved and that was maintained by splints made of a different material.
The other child with a unilateral clubfoot with a fair result was from a family background where the grandfather firmly believed that the cast was the cause of thin calf. The corrective process ended up to be very erratic and required a prolonged treatment time.
One child with a bilateral clubfeet had a poor result due to a practical difficulty of maintaining the casts. The shape of the limb was conical allowing the casts to slip off time and again. The correction suffered and hence both feet had to be operated. Figure 10 Case 2: At 2 years of age. Figure 11 Case 3: Newborn with bilateral clubfeet. Figure 12 Case 3: Second manipulation and casting of right side shown. Figure 13 Case 3: At 3 years of age.
Figure 14 Allergy to splints—fair result. Principles of its correction as laid down by Ponseti are time-tested, widely accepted and show excellent results. One does not have an extra help from any allied medical personnel to educate and counsel families on a regular short-term basis like one does in the developed countries of in the west. We changed plasters between 7 and 14 days average 10 which helped the family to plan their arrival in advance. An average of 6 cast changes was found to be needed before the tendo-Achilles release.
Once the complete management protocol was dis- cussed in detail on their first visit, no family had any problem with the time required to achieve full correction. We feel that it is impossible to achieve the recommended single incision full tenotomy of tendo-achilles percutane- ously, ensuring that the sheath is intact, as an outpatient department OPD procedure using local anesthesia. Hence, the step correction of tendo-achilles under the supervision of a paediatric intensivist and proper monitoring not as an OPD procedure ,11,12 is just playing safe in this day and age of multiple lawsuits.
Although the efficacy of foot-abduction brace as a dynamic orthosis for the maintenance of correction is well established, it is only based on the assumption that all families are comfortable using it and are thoroughly compliant, espe- cially immediately after full correction. Sadly, compliance was a huge issue with foot abduction orthosis FAO in most families coming to us. In fact, it was more difficult to convince them that an FAO will not be an obstacle in the motor develop- ment of their child.
No family had problems in using this orthosis even for a longer period of time. We preferred a less accept- able but more compliant orthosis to the more acceptable and more effective but much less compliant one and achieved good results. Barefoot walking mainly, along with the usage of CTEV shoe in the initial years, helped us to maintain correction dynamically.
We feel that it is imperative to keep a regular follow-up during the period of growth, even after the best of achieved corrections. Xu RJ. A modified Ponseti method for the treatment of idio- pathic clubfoot: a preliminary report. J Pediatr Orthop ; — Staheli L. Treatment of idiopathic clubfoot using the Ponseti method: minimum 2-year follow-up.
J Pediatr Orthop B ; — Ponseti versus traditional methods of casting for idiopathic clubfoot. J Pediatr Orthop ;— Plaster cast treatment of clubfoot: the Ponseti method of manipula- tion and casting. J Pediatr Orthop Part B ;—7. Radical reduc- tion in the rate of extensive corrective surgery for clubfoot using the Ponseti method. Pediatrics ;— A histomorphometric and immunohistochemical study of fetuses. An electron microscopic study of the fascia from the medial and lateral sides of clubfoot.
Users Online: Home. Management of clubfoot by ponseti method: A prospective study. J Orthop Allied Sci ; Figure 1: At initial presentation Click here to view. Figure 2: After first cast application Click here to view. Figure 3: Right foot after second cast application Click here to view. Figure 4: Left foot after second cast application Click here to view. Figure 5: Right and left foot after third cast application Click here to view. Figure 6: Both feet after fourth cast application Click here to view. Figure 7: After percutaneous tendo-achilles tenotomy right Foot Click here to view.
Figure 8: After percutaneous tendo-achilles tenotomy left foot Click here to view.
Figure 9: Right foot after final correction Click here to view. Figure Left foot after final correction Click here to view. Figure At 12 months follow-up, patient in the standing position front Click here to view. Figure At 12 months follow-up, patient in standing position back Click here to view. Figure At 12 months follow-up, the left foot as seen from side Click here to view. Figure At 12 months follow-up, the right foot as seen from side Click here to view. Figure At 12 months follow-up, patient in the squatting position Click here to view.
Table 1: Different age of presentation in all the groups Click here to view. Table 2: Need of tenotomy with different groups Click here to view. Table 3: Complications Click here to view. Table 4: Comparison of results with age at presentation Click here to view.