EVALUATION OF PONSETI METHOD IN SYNDROMIC CLUBFOOT DEFORMITIES
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Keywords
Pontesi cast, fracture, paediatric, clubfoot
Abstract
Objective: This research aimed to evaluate the effectiveness of Ponseti casting in managing syndromic clubfoot deformities.
Study design: quasi-experimental study
Place and Duration: This study was conducted in Bolan Medical College Hospital Quetta from March 2023 to March 2024
Methodology: Infants under one year old with syndromic clubfoot and no prior interventions were included. Exclusion criteria were prior treatments, parental refusal, or specific conditions. Initial assessments involved photographs and Pirani scoring before starting the casting. Weekly casting sessions were documented, with selective Achilles tenotomy performed when necessary before the final cast. Post-treatment documentation and Pirani scoring were conducted, with follow-ups at 3 and 6 months to monitor recurrence and need for surgery. Data analysis was performed using SPSS version 26.
Results: The study enrolled 90 children (60 males, 30 females) with 70 bilateral and 20 unilateral clubfeet. Initial Pirani scores indicated significant deformity, requiring various numbers of casts and occasional tenotomy. Despite challenges, notable improvement was observed. The mean pre-treatment Pirani score was 4.0 (±0.75), reduced significantly to 2.0 (±0.5) post-treatment (p < 0.001). Recurrence occurred in 35 (39%) children, with 18 (20%) needing surgical intervention.
Conclusion: Ponseti casting is effective in correcting syndromic clubfoot deformities, though it requires more casts. The method is recommended for this patient population despite the challenges.
References
2. Davis M, Harris N. Management of complex clubfoot using differential distraction. Curr Med Res Pract. 2019;9(5):176-81.
3. Ponseti IV, Smoley EN. Congenital clubfoot: results of treatment. Clin Orthop Relat Res. 2009;467(5):1133-45.
4. Smith MB, Rudzki JR, Purcell DB, et al. Predictors of outcome after Ponseti method for idiopathic clubfeet. J Bone Joint Surg Am. 2004;86(1):22-7.
5. Khan M, Majoka MW, Qureshi AH, Abidi SA. Ponseti method for idiopathic clubfoot: five-year follow-up. Clin Orthop Relat Res. 2009;467(5):1263-70.
6. Smythe T, Kuper H, Macleod D, et al. Birth prevalence of congenital clubfoot in low- and middle-income countries: a systematic review. Trop Med Int Health. 2017;22(3):269-85.
7. Bor N, Coplan JA, Herzenberg JE. Ponseti treatment for idiopathic clubfoot: minimum 5-year follow-up. Clin Orthop Relat Res. 2009;467(5):1263-70.
8. Filberto F. Diagnosis and management of congenital talipes equinovarus. Cermin Dunia Kedokteran. 2016;48(1):399699.
9. Shabtai L, Specht SC, Herzenberg JE. Global spread of the Ponseti method for clubfoot. World J Orthop. 2014;5(5):585-90.
10. Zionts LE, Sangiorgio SN, Ebramzadeh E, et al. Current management of idiopathic clubfoot: results of a survey. J Pediatr Orthop. 2012;32(5):515-20.
11. Zionts LE, Zhao G, Hitchcock K, et al. Has the rate of extensive surgery to treat idiopathic clubfoot declined? J Bone Joint Surg Am. 2010;92(4):882-9.
12. Morcuende JA, Abbasi D, Dolan LA, et al. Ponseti method for idiopathic clubfoot: five-year follow-up. Clin Orthop Relat Res. 2009;467(5):1263-70.
13. Dyer PJ, Davis N. Pirani scoring system in clubfoot management. J Bone Joint Surg Br. 2006;88(8):1082-4.
14. Smith MB, Rudzki JR, Purcell DB, et al. Predictors of outcome after Ponseti method for idiopathic clubfeet. J Bone Joint Surg Am. 2004;86(1):22-7.
15. Brown JA, Morcuende JA, Dolan LA, et al. Recurrence rate of clubfoot treated with Ponseti method. Pediatrics. 2004;113(2):376-80.
16. Jones LE, Dietz FR. Bracing after Ponseti correction of idiopathic clubfoot. J Am Acad Orthop Surg. 2010;18(8):486-93.
17. Taylor H, Hägglund G, Jarnlo GB, et al. The Ponseti method in Sweden: results after two decades. J Child Orthop. 2016;10(5):479-85.
18. Guruprasath A. Functional outcome of serial cast correction of congenital talipes equinovarus by Ponseti method (Doctoral dissertation, Government Mohan Kumaramangalam Medical College, Salem). 2015
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Khurram Shahzad Shahwani
Assistant Professor Orthopedics Department, Jhalawan Medical College (JMC), Khuzdar Pakistan.
Imtiaz Ahmed Tago
Associate Consultant Orthopedics, Al Wakrah Hospital Hamad Medical Corporation HMC Surgery Department Doha Qatar.
Muhammad Azfar
Specialist/Registrar Orthopedic Surgery, Dr Sulaiman Al-Habib Medical Group, Riyadh, KSA.
Zeeshan Faisal
Associate Professor and Consultant Orthopaedic Surgeon, Hamdard University Hospital & Taj Medical Complex Karachi Pakistan.
Kashif Anwar
Consultant Orthopedic Surgeon, Jinnah Postgraduate Medical Centre Karachi Pakistan.
Mohammed Asif Peracha
Consultant Orthopedic Surgeon, Liaquat National Hospital and Medical College Karachi Pakistan.