Congenital Talipes Equino Varus in Infants: Management By Ponseti Method and Outcome

CONGENITAL TALIPES EQUINO VARUS IN INFANTS MANAGEMENT BY PONSETI METHOD AND OUTCOME Author name Dr A. Thirupathi Reddy, Associate prof of Pediatrics, Guntur medical college, Guntur, AP Co-author name Dr K. Kishore Kumar, Assistant Prof of Orthopedics, Guntur Medical College, Guntur, AP Dr B. Joseph kartheek, Resident, Dept of Orthopedics, Guntur Medical College, Guntur, AP OBJECTIVE CTEV in infants is a commonest Orthopedic problems for which there are many methods to treat. Our study is a descriptive analysis of Ponseti method and management of CTEV and its outcome. SETTING Orthopedic ward of tertiary care teaching hospital in South India DESIGN A 2 year prospective longitudinal hospital based observational study and its outcome PARTICIPANTS 30 infants with 43 idiopathic clubfoot from 1st week of life to 1 year after birth excluding those infants with associated congenital malformations. RESULTS Out of 30 (21 males & 9 females) infants, 17 had unilateral clubfoot & 13 had bilateral clubfoot (total 43 club foot). The mean age of the presentation to treatment was 3 weeks. Depending upon the response to Ponseti method of management, the number of castings required prior to tenotomy varied with each patient (7 castings in 7 patients, 8 castings in 18 & 9 in 5 infants). Out of 43 clubfoot, 41 (95.35 %) had achieved normal corrections, 2 (4.65 %) required post operative soft tissue release, 38 (88.37 %) had undergone percutaneous tenotomy & 3 (6.97 %) got corrected without tenotomy. All the feet were applied with Dennis Brown splint and after 2 year period of follow up, out of 43 clubfoot, 6 (13.95 %) relapses occurred, 4 (9.30 %) were equinus, 2 (4.65 %) were equino-cavo-varus and subsequently the relapses were corrected surgically. CONCLUSIONS Ponseti method is a safe, effective technique to treat CTEV which radically reduced the need for extensive surgery. This method enables us to correct most idiopathic clubfoot with gentle manipulation, casting and percutaneous tenotomy. Bracing is the key to long term success of the Ponseti method and also to prevent relapses requiring major surgical interventions. congenital talipes equino varus, clubfoot, Ponseti method, Infant, Outcome