EFFICACY OF PONSETI METHOD IN THE MANAGEMENT OF IDIOPATHIC CLUBFOOT

Introduction-Idiopathic congenital talipes equinovarus (Club Foot) is a complex deformity that is difficult to correct. The goal of the treatment is to obtain painless, plantigrade, and functionally acceptable foot. Currently, Ponseti method of clubfoot management is accepted worldwide, which includes serial corrective manipulation and pop casting and a possible percutaneous achilles tenotomy in select patients. The purpose of this study was to evaluate the effectiveness of the Ponseti method and factors influencing the outcome in the management of congenital idiopathic clubfoot. Material and Methods- We have treated 71 patients with 105 clubfeet using Ponseti method of management. Childrens less than 1 year of age with only idiopathic clubfoot were included in the study. We divided the patients into 4 group based on the age at presentation , at the commencement of the treatment. The severity of foot deformity was assessed according to the Pirani scoring system. Total number of the casts applied before tenotomy, timing of tenotomy and fitting of foot abduction brace were noted. Results-In our study average duration to obtain correction varied according to the age at beginning of treatment, with least number of casts (5.5 cast ) required for correction in group 1 , whereas 11.2 casts are needed in the group 4 patients. 44 patients Out of 71 needed percutaneous tenotomy. Initial correction was obtained in all 105 clubfeet with the Ponseti method. 10 children had a relapse of the deformity due to non-compliance of the use of foot abduction brace. Conclusion The Ponseti method is a safe and effective treatment for congenital idiopathic clubfoot that alleviates the need for extensive corrective surgery. we conclude that age at initial presentation , severity of foot deformity ,parents compliance ,casting technique , adherence to bracing protocol were the major determinants of duration and relapses in the management of clubfoot.