Analysis of efficacy of Ponseti Method in management of Idiopathic Clubfoot

Prabhu, V A (2009) Analysis of efficacy of Ponseti Method in management of Idiopathic Clubfoot. Masters thesis, Coimbatore Medical College, Coimbatore.

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Abstract

INTRODUCTION: Congenital Talipes Equino Varus is a complex developmental deformation occuring in an otherwise normal child. It is one of the most common congenital orthopaedic anomalies first described by Hippocrates as early as 400 BC. However it still continues to challenge the skills of Orthopaedic surgeon as it has a notorious tendency to relapse whether it is treated conservatively or operatively. Part of the reason that the foot relapse is surgeon’s failure to recognize the pathoanatomy. The goal of treatment is to attain a functional, painfree, plantigrade foot, with good mobility without calluses, and without the need to wear special or modified shoes. . Many of these cases are untreated or poorly treated, leading to neglected clubfoot. These children undergo extensive corrective surgery, often with disturbing failures and complications. Revision surgeries are also thus more common. Although the foot looks better after surgery, functionally it is stiff, weak, and often painful. After adolescence, pain increases and often becomes crippling. Clubfoot in an otherwise normal child can be corrected in two months or less with the Ponseti method of serial manipulations and plaster cast applications, with minimal or no surgery. This method is particularly suited for developing countries, where there are few orthopaedic surgeons in rural and remote areas. The technique is easy to learn by allied health professionals, such as physiotherapists and orthopaedic assistants. The treatment is economical and safe. Aim of the Study: The aims of the study are 1. To analyse the efficacy of Ponseti method of serial manipulation and casting in the management of Congenital Idiopathic Clubfoot. 2. To evaluate the efficacy of Ponseti method in reducing the need for corrective surgeries and its complications. 3. To compare the educational status of the parents and their compliance in bracing and follow up. 4. To analyse the usefulness of Ponseti method in Idiopathic Clubfoot in a developing country like India. MATERIALS AND METHODS: The study was carried out in patients having classical idiopathic clubfeet who were less than 5 months of age (5 to 90 days) attending the clubfoot clinic in the Department of Orthopaedics, Coimbatore Medical College Hospital, Coimbatore , Tamilnadu , India. Thirty two children (47 feet) were treated by the Ponseti method between June 2007 to June 2009 and followed for a period of 6mo to one year. The cases were referred to us from paediatric wards, paediatric surgery wards and obstretics wards. Four babies manipulated and given serial casting & declared failure elsewhere, were referred for treatment. All the patients were treated on an outpatient programme. An informed consent was taken from the parents regarding management, complications & compliance. Older patients or those having non-idiopathic deformities were excluded from the study Every clubfoot under Ponseti management was “scored” each week for HS (hindfoot score), MS (mid-foot score), and G (total score). Manipulation and casting were carried out without any anaesthesia or sedation. RESULTS: A total of 47 feet [17 males (53%) and 15 females (47%)] in 32 children were treated by the Ponseti method and the results were assessed in the present series, carried out from June 2007 to June 2009 followed for a period of six to twelve months. Fifteen children had bilateral clubfeet, nine were unilateral on right side and eight were left sided. Forty one feet (87%) were of first-born children. Forty one feet (87%) were of children born full-term. The most common associated congenital anomaly in our studies was Umblical hernia (four cases). Next common was Developmental dysplasia of hip (two cases). Internal tibial torsion was seen in one of the cases. Twenty eight cases (87.5%) presented within six weeks. The total mean score at presentation was 3.79. The corresponding HS (hindfoot )score and S(midfoot)score were 1.96 and 1.83 respectively. The majority of cases mean of 5.3. The average duration of cast application was 5.3 weeks. Tenotomy was required in 28 cases (87.5%) and most of these had Pirani scores of more than 3. The average duration of follow-up was 9 months. Ten cases of relapses were encountered during follow-up. Of these four were forefoot adduction, five were equinus and one cavus. Equinus required repeat tenotomy, while the rest were all treated with repeat casting. Correction without surgery was obtained in twenty eight cases. Four (12.5%) patients were considered failure after treatment by the Ponseti method & required corrective Posteromedial soft tissue release. Following surgery, all the four patients had Pirani score of less than 1.0. No postoperative wound infection was noted. CONCLUSION: The Ponseti method is a very safe, efficient treatment for the correction of Idiopathic Clubfoot that decreases the need for extensive corrective surgery and its complications. Following the principles and technical details of Ponseti method will assure optimal results in almost all patients. Babies presenting early have an excellent chance of achieving full correction with fewer casts with or without percutanoeus tenotomy of tendoachilles. Babies of parents, who are better educated have more compliance in following instructions regarding splint and shoes application and follow up. In a developing country like India, where there is dearth of proper operative facilities in remote areas, Ponseti technique is an easy, safe, result-oriented and economical method of Clubfoot management.

Item Type: Thesis (Masters)
Uncontrolled Keywords: efficacy of ponseti method ; management of idiopathic clubfoot.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 18 Sep 2017 01:10
Last Modified: 18 Sep 2017 01:34
URI: http://repository-tnmgrmu.ac.in/id/eprint/3007

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