Management of idiopathic CTEV by Ponseti method: A prospective study
Reneesh Uruniyan Paramban, Rahul MK
Background: Congenital idiopathic clubfoot is a complex deformity which occurs in an otherwise normal child. The Ponseti method of clubfoot management has been shown to be effective, producing better results and fewer complications than traditional surgical methods. The Ponseti technique is a well-proven way of managing paediatric clubfoot deformity. We describe a management set-up which spreads the care between secondary and tertiary care with no loss of quality.
Patients and Methods: Data was collected from patients with idiopathic clubfoot, presenting at Kerala Medical College & Hospital, Palakkad a teaching institution between October 2015 to October 2017. Both unilateral and bilateral were included in the study.
In present series, we have treated 30 children with idiopathic clubfoot by Ponseti method of correction of serial manipulation and casting. Among the 30 children, 17 had unilateral and 13 bilateral involvement. Most children had grade III and grade IV (Dimeglio et al grading) deformity. The mean number of casts required was 5.76 (4 to 10). Tenotomy was required in 12 feet (40%). The scores for the entire group ranged from 4.0 to 7.0 (of 10) and 4 to 19 (of 20) in the Dimeglio classification. Pirani scores for the age group 0- 6 months were 4.46, 6 months to 1 year were 5.36 and 1-2 years were 5.75 respectively. The results were excellent in 88.3% and good in 11.7%. Initial and final scores were statistically evaluated with paired ‘T’ test with a ‘T’ value of 36.76 with a ‘P’ value of less than 0.001. Thus there was a significant reduction in the score from the pre level because of intervention.
Results: Similar good results and low requirement for surgical interventions other than Achilles tenotomy, which forms part of the Ponseti regimen, were found. In terms of number of patients the success rate is 87% and in terms of the number of feet the success rate is 91%.
Conclusions: This study demonstrates that treatment of congenital talipes equine varus by conservative management of ponseti method can be sufficient.