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Temporal Variation of Scores Along the Course of the Ponseti Treatment in Older Children

A Ready Guide to Progress of Treatment

Agarwal, Anil MS (Orthopaedics); Shanker, Mukesh MS (Orthopaedics)

doi: 10.1097/BPO.0000000000001428
Original Article: PDF Only

Purpose: We aimed to graphically study the correction trend along the course of Ponseti treatment in older children with idiopathic clubfeet.

Methods: The temporal variation of total Pirani and Dimeglio scores and their individual components at each casting session was represented graphically. Tenotomy correction was accounted for separately. We classified 0 to 4 as early, 4 to 8 as midlevel, and beyond 8 as late casts to describe the sequence of treatment.

Results: A total of 27 patients (39 feet; bilateral in 12) were studied. The average patient age was 4.78±2.36 years. Rigid equinus was the more severe pretreatment deformity in Pirani system and also the most difficult to treat component. Posterior crease and medial crease were least severe and were treated in early casts. Reducibility of lateral head of talus, curved lateral border of foot, and empty heel were moderately severe and showed a gradual improvement pattern over subsequent casting sessions. For Dimeglio components, equinus was the most resistant deformity, and it persisted until late casts. Adduction, rotation, and varus were moderately severe, and they followed a gradual improvement slope. Several components/scores did not turn 0 after correction for older clubfoot children.

Conclusions: The treatment graphs for older clubfoot children adequately illustrated the initial severity, number of Ponseti casts used, correction of total scores and their individual components over sequential casting sessions, tenotomy influence, and the residual deformities.

Department of Paediatric Orthopaedics, Chacha Nehru Bal Chikitsalaya, New Delhi, Delhi, India

A.A: study design, statistical analysis, and manuscript preparation; M.S.: performed measurements and was involved in manuscript preparation.

Financial conflicts: nil.

The authors declare no conflicts of interest.

Reprints: Anil Agarwal, MS (Orthopaedics), 4/103, East End Apartments, Mayur Vihar Phase 1 Extension, New Delhi 110096, Delhi, India. E-mail:

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