MANAGEMENT OF CONGENITAL TALIPES EQUINOVARUS BY PONSETI METHOD

INTRODUCTION: Idiopathic congenital talipes equinovarus (CTEV), a congenital deformity that has plagued the medical profession and society before the days of Hippocrates. Most of the orthopedic surgeons are now of the opinion that the initial treatment of clubfoot should be nonoperative. Many different method of nonsurgical treatment are being used with reported success rate from 15 to 90%. Sir Ignatio Ponseti a leading advocate of conservative treatment of clubfoot by serial casting achieves excellent result if instituted early. The present study, therefore, has been undertaken to determine the treatment outcomes of patients treated with ponseti casting technique and establish if results produced by ponseti method is reproducible. AIMS OF STUDY: 1. To study and evaluate the Ponseti method of treatment of congenital talipes equinovarus. 2. To obtain a painless, plantigrade, pliable, cosmetically and functionally acceptable foot. MATERIALS AND METHODS: The study was conducted in the Department of Orthopedics, Hindu rao hospitals between July2009 to nov2010. A total of 30 feet of 25 patients were included in the study between the age of 1week to 6 months. INCLUSION CRITERIA Children with virgin idiopathic clubfoot in the age group of 1week to 6 months. EXCLUSION CRITERIA: a. Secondary clubfoot. b. Those that has already treated by other than Ponseti method. c. children with age 6 months. Clinical assessment Quantification of various components of clubfoot deformity using the Pirani score. RESULTS: In the present study with 25 patients with 30 feet, total duration of our study was 16 months. With average follow up of 11 months. ranges from 6 to 15months, 1 patient with bilateral clubfoot lost in follow up, 4 were shifted to surgical treatment the cause being, severe deformity and noncompliance to conservative technique. Of the remaining 20 patient with 24 feet where treated by ponseti method and the clinical results were assessed and compared. The results of our series were assessed clinically according to Pirani’s classification. CONCLUSIONS: Ponseti serial corrective cast management is an easy, effective and economical method of CTEV correction when it is applied in idiopathic clubfoot. Treatment must start at earliest possible age. Result of method is excellent when it was applied within a golden period of CTEV that means in initial 0-3 months of newborn. Result can be clinically evaluated by Pirani score. Strict compliance in foot abduction brace after full correction produces good results.