CLINICAL AND RADIOLOGICAL ASSESSMENT OF THE EFFECTIVENESS OF PONSETI TECHNIQUE IN TREATMENT OF CONGENITAL TALIPES EQUINOVARUS

Abstract

Congenital talipes equinovarus (clubfoot) is one of the most common congenital anomalies encountered in pediatric orthopedics. Its incidence is about 1:1000 live births. It remains a challenge not only to understand its genetic origins but also to provide effective long-term treatment and prevention of recurrences. Clubfoot can lead to serious walking problems if left untreated. Conservative treatment with the Ponseti method has revolutionized the clubfoot treatment and has been adopted globally in the last decades. Surgical treatment is indicated only after failure of conservative methods. Surgical release rate of the idiopathic clubfoot has decreased significantly since the emergence of the Ponseti method. The aim of this study was the evaluation of using ponseti technique for correction of cases of idiopathic CTEV deformity by clinical and radiological follow up aiming at determining benefits, drawbacks and obstacles to this technique . Between March 2020 and March 2021, total of 26 patients with 40 feet affected with congenital talipes equinovarus were treated using the Ponseti technique at the outpatient clinic of the orthopedics department of Sohag university hospital. Pirani scoring system was used for clinical evaluation of clubfeet. All patients had pre-treatment , post-correction and last follow-up plain radiographs that included antero-posterior (AP) and lateral dorsiflexion stress views of the feet. The antero-posterior and lateral talo-calcaneal angles (TCA) were measured and were used to calculate the talocalcaneal index (TCI). 16 patients (61.5%) were male, 10 (38.5%) patients were female. 14 patients (53.8%) had bilateral involvement, 12 patients (46.2) were unilateral. The age of patients at the time of presentation varied from one week to one and a half year with the mean age was 5 months. The mean number of the casts required was greater for the group that required tenotomy than the group that did not require tenotomy. Tenotomies were performed on 14 feet of 40 (35%) while 26 feet (65%) did not require tenotomy. The average initial Pirani score in this study was 5.0 range from (2-10) while the average final Pirani score ranged from (1 -1.5). Final results of correction according to Pirani score were excellent in 18 feet (45%), Fair in 20 feet (50%), and poor in 2 feet (5%). There was a statistically significant improvement in the mean values of the radiological parameters including TCA on AP and lateral views, and TCI after treatment when compared with the values at presentation. Ponseti technique of serial manipulation and cast is an easy, efficient, economical and reliable method of CTEV correction when it is applied early with 95 % success rate.