Early outcomes of Modified Ponseti Method of Manipulation for Management of Cases of Atypical Clubfoot in Children
Abstract
Introduction: Atypical clubfoot forms a small subset of idiopathic clubfoot, features of which are more severe, is difficult to treat using normal Ponseti casting, and treatment often requires modifications. We therefore undertook this study to evaluate the role of modified Ponseti method of manipulation in management of atypical clubfoot.
Materials and methods: We evaluated 30 atypical clubfeet in a prospective, descriptive study conducted at a tertiary care centre in central India and used modified Ponseti casting for its management. Achilles tenotomy was performed in all patients, followed using a foot abduction brace. All children of age less than three years, presenting with features of atypical clubfoot were included in the study. Children with typical or having secondary clubfoot or with history of previous surgical treatment were excluded from the study. Children were followed-up for minimum of six months after tenotomy. Severity assessment was done using Pirani score.
Results: Our study included 30 feet in 18 children (12 bilateral and 6 unilateral) and Male to Female ratio was 2:1 (12:6). On an average 9.44 casts were required for correction in each foot and mean treatment duration was 11.44 weeks. Three patients had excellent results, 25 had good and 2 had poor results. Second tenotomy was required in two cases. Complications included pressure sores in 8 patients, cast slippage in 13/267 casts and relapses in 2 patients.
Conclusion: Management of Atypical Clubfoot is a challenge for orthopaedic surgeon, early identification and treatment with modified Ponseti technique provides good to excellent results in most of the patients and reduces the need for major surgical intervention.
Abstract | Reference
