A retrospective study of idiopathic clubfoot managed by Ponseti method using Pirani and Dimeglio scoring, in Indian population: a minimum 3-year follow-up

Abstract

Congenital talipo-equino-varus (CTEV) is one of the most common congenital deformities affecting children in India with an incidence of 1.19/1000 live births. Ponseti treatment regimen has been established as the gold standard of care for idiopathic clubfoot. We present quantitative and qualitative analysis of the results of Ponseti management in early presenting idiopathic clubfoot cases, with a minimum follow-up of three years after correction. We retrospectively analysed the data of 122 children (comprising a total of 191 feet) who were treated for clubfoot by the standard Ponseti method with a minimum 3-year follow-up post-correction at our clinic. All cases were treated under the supervision of a single senior Paediatric Orthopaedic Surgeon. The mean age at onset of treatment was 2.3 months. Mean follow-up period was 4.2 years. The mean number of casts applied was 6.7. The mean duration of treatment until the application of splint was 9.5 weeks. The mean Pirani score at the commencement of treatment was 4.5. At the completion of treatment (around 3.6 years of age), the Dimeglio score was ‘Benign’ (Good) in 106 cases, ‘Moderate’ (Fair) in 11 cases and ‘Severe/Very Severe’ (Poor) in 5 cases. The P-value was calculated to be 0.8 for the sex-wise comparison of the treatment outcome. Ponseti method of nonoperative treatment for idiopathic clubfeet remains a gold standard for all cases treated during infancy. Identifying atypical clubfeet is important as their prognosis ought to be guarded. Despite facing problems at various stages of management, adhering to the basic treatment principles laid down by Ponseti helps in achieving good outcomes in majority. Level of Evidence: IV.