Evaluation of Effectiveness of Steenbeek Foot Abduction Orthosis in Maintaining Correction in Clubfoot Treatment by Ponseti Method

Introduction The Ponseti method comprises of serial manipulation and a specific casting technique, with Achilles tenotomy, when needed, to correct any remaining equinus deformity, followed by the use of a foot abduction orthosis (FAO). Treatment is evaluated using the Pirani scoring. The Steenbeek brace developed in Uganda by Michiel Steenbeek, is made with local tools and materials. The cost is under 500 rupees and matches the recommendations provided by Dr. Ponseti. Our objective is to evaluate the efficacy of this low cost orthosis in a resource restricted patient population. Materials and Methods A prospective cohort study was done for 1 year on children presenting at age less than1 with clubfoot and treated in our hospital. Children with assocaited conditions like arthrogyroposis, spina bifida or other lower limb disorders and previously treated elsewhere were excluded from the study. Results Out of 50 patients (76 feet). Mean age of starting treatment was 1.24 weeks and mean initial Pirani score was 4.64. Tenotomy was done in 81.6 % (62/76). Mean score at brace application was 0.64. Rate of recurrence was 10.5 %. Rate of compliance was 89.5 %. Recurrence showed highly significant correlation with non compliance (pless than0.001). Discussion FAO is recommended to reduce the risk of recurrence. Compliance is a major factor influencing recurrence. Dennis Brown bar as well the Mitchell Ponseti braces had lower rates of compliance and a high recurrence rates whereas in our study with Steenbeek orthosis compliance was 89.5 % and recurrence rate was 10.5 % proving it to be a cost effective approach to reduce recurrence in clubfoot in developing countries.