Comparative analysis of correction of idiopathic congenital talipes equinovarus by conventional and accelerated Ponseti method with minimum 12 months follow up in a tertiary care hospital in North India
Keywords:CTEV, Accelerated Ponseti casting, Pirani
Background: Congenital talipes equinovarus varus (CTEV) is one of the most common congenital anomalies of foot and ankle affecting 1/1000 live birth approximately. With a male dominance pattern, this deformity is bilateral in 50% cases. It has four basic components: cavus, adduction, varus and equinus. Severity of clubfoot is accessed using Pirani score (0 to 6). Insights into the basic pathoanatomy of this complex 3 dimensional deformity has helped to correct it using the method given by Ignacio Ponseti, a Spanish orthopaedician, in which serial manipulations of foot are done and weekly casts are applied, followed by a tendoachilles tenotomy in selected cases to correct the equinus component which is then followed by splintage of the feet in Steenbeek splint initially for 23 hours day for 3 months and then 12 hours a day for 3 years. The most important component of this treatment is parental counselling regarding the need for compliance with treatment which is often loophole responsible for relapse in initially corrected feet.
Methods: This was a prospective study including 40 patients (61 feets) of idiopathic clubfoot with age <3 month at presentation who were randomly distributed in two groups, group 1 (accelerated Ponseti casting group) in which twice weekly casts were applied and group 2 (standard Ponseti casting group) in which weekly casts were applied. Initial Pirani score was calculated in all the patients and was rechecked and documented in every successive visit. All the patients were followed upto 12 months and there was no lost to follow up in this study.
Results: The mean days of plaster duration in accelerated casting group was 18.45 days as compared to 47.25 days in standard casting group (statistically significant, p value <0.05). Also, Pirani score at the end of last follow up was comparable in both the groups. Tenotomy rate was slightly higher in accelerated casting group (89.5%) as compared to standard group (85.7%) which may be attributed to higher initial Pirani score in former (5.5) as compared to later (5.0).
Conclusions: Accelerated biweekly Ponseti casting reduces the overall days of treatment with similar results compared to standard weekly casting regime.
Wynne-Davies R. Genetic and environmental factors in the etiology of talipes equinovarus. Clin Orthop Rel Res. 1972;84:9-13.
Azar FM, Canale ST, Beaty JH. Campbell’s Operative Orthopaedics, 13th edition, Elsevier. 2017.
Siapkara A, Duncan R. Congenital talipes equinovarus: a review of current management. J Bone Joint Surg [Br]. 2007;89-B:995-1000.
Chung CS, Nemechek RW, Larsen IJ, Ching GH. Genetic and epidemiological studies of clubfoot in Hawaii: general and medical considerations. Hum Hered. 1969;19:321-42.
Clubfoot VJT. Current problems in Orthopaedics New York: Churchill Livingstone. 1981.
Agrawal RA, Suresh MS, Agrawal R. Treatment of congenital club foot with Ponseti method. Indian J Orthop. 2005;39:244-7.
Cosma DI, Vasilescu DE. Ponseti treatment for clubfoot in Romania: a 9- year single-centre experience. J Pediatr Orthop. 2014;23(6):512-6.
Ponseti IV. Treatment of congenital club foot. J Bone Joint Surg Am. 1992;74:448‐54.
Cooper DM, Dietz FR. Treatment of idiopathic clubfoot. A thirty year follow up note. J Bone Joint Surg Am. 1995;77:147789.
Macnicol MF. The management of club foot: Issues for debate. J Bone Joint Surg Br. 2003;85:16770.
Solanki M, Ajmera A, Rawat S. Comparative study of accelerated ponseti method versus standard Ponseti method for the treatment of idiopathic clubfoot. J Orthop Traumatol Rehabil. 2018;10:116-9.
Ullah S, Inam M, Arif M. Club foot management by accelerated Ponseti technique. RMJ. 2014;39:41820.
Scher DM, Feldman DS, van Bosse HJ, Sala DA, Lehman WB. Predicting the need for tenotomy in the Ponseti method for correction of clubfeet. J Pediatr Orthop. 2004;24:34952.
Morcuende JA, Abbasi D, Dolan LA, Ponseti IV. Results of an accelerated Ponseti protocol for clubfoot. J Pediatr Orthop. 2005;25:623-6.
Xu RJ. A modified Ponseti method for the treatment of idiopathic clubfoot: a preliminary report. J Pediatr Orthop. 2011;31(3)317-9.
Harnett P, Freeman R, Harrison WJ, Brown LC, Beckles V. An accelerated Ponseti versus the standard Ponseti method: a prospective randomised controlled trial. J Bone Joint Surg Br. 2011;93(3):404-8.
Sharma P, Yadav V, Verma R, Gohiya A, Gaur S. Comparative analysis of results between conventional and accelerated Ponseti technique for idiopathic congenital clubfoot. Orthop J. 2016;22:37.
Haft GA, Walker CG, Crawford HA. Early clubfoot recurrence after use of the Ponseti method in a New Zealand population. J Bone Joint Surg [Am]. 2007;89-A:487-93.
Giesberts RB, Van der Steen MC, Maathuis PGM, Besselaar AT, Hekman EEG, Verkerke GJ. Influence of cast change interval in the Ponseti method: A systematic review. PLoS One. 2018;13(6):e0199540.
Garg S, Porter K. Improved bracing compliance in children with clubfeet using a dynamic orthosis. J Child Orthop. 2009;1:271-6.