EFFECTIVENESS OF PONSETI’S TECHNIQUE FOR THE TREATMENT OF IDIOPATHIC TALIPES EQUINOVARUS IN CHILDREN

Main Article Content

Dr. Sundas Mastoi
Dr. Zimyad Ali Mastoi
Dr. Qurat-ul-Ain
Muhammad Salman Rasool
Dr. Samina Gul Memon
Dr. Pashmina Shaikh
Dr. Umbreen Bano
Dr. Shazia Begum Shahahni
Dr. Muhammad Yaqoob Shahani

Keywords

Ponseti’s technique, Idiopathic clubfoot, Children

Abstract

Objective: To assess the outcome of Ponseti technique to treat of idiopathic talipes equinovarus in young ones not more then  2 years .


Methodology: Total of 125 children of idiopathic talipes equinovarus were reported in OPD of orthopeadic PUMHS, Nawabshah. Clinical examination of the patient was done and recorded in proforma. The reported cases of clubfoot in this study was classified as stated by  the Pirani scoring system and then series of changes followed by every week over the knee castings.


Results: The age was <2 years and more boys 94(75.20%) compared to girls 31(24.8%). The 54 (43.20%) bilateral deformities and 71 (56.80%) unilateral deformities were observed. The soft mobility of foot in 135(75.4%) while rigid mobility of foot in 44(24.6%) was noticed. Group-I which have results of 1.5 - 2.5 numbering was seen in 55 feet (30.72%). Group-II which have results  of 3 - 4.5 numbers was observed in 98 feet (54.74%) and group-III having results of ≥ 5 points were observed in 26 feet (14.52%). In group-II having results  of 3 to 4.5 points, 19 feet (10.61%) engage in percutaneous tenotomy, while in group-III having results of ≥ 5 points, 15 feet (8.37%) need the tenotomy. Over all percutaneous tendon release was performed in 34(19%) children. The 78.4% of sufferers give satisfactory results and nearly 12.8% had good outcome and 8.8% of sufferers had bad outcomnes.


Conclusions: In the end, the Ponseti method is a secure and economical therapy for congenital idiopathic clubfoot and radically decline the requirment for large surgical approach.

Abstract 71 | Pdf Downloads 6

References

1. Agarwal S, Suresh B, Varghese M, Khanna V, Bajaj MS. Functional outcome of tendoachilles following Ponseti‘stenotomy for treatment of congenital talipes equino varus in children older than two years. Int J Res Orthop 2017;3:1057-61.
2. Gunalan R, Mazelan A, Lee YP, Saw A. Pattern of Presentation and Outcome of Short-term Treatment for Idiopathic Clubfoot/CTEV with Ponseti Method. Malaysian orthopaedic journal. 2016 Nov;10(3):21-5.
3. Baghdadi T, Bagheri N, Najafi A, Mansouri P, Farzan M. Ponseti casting method in idiopathic congenital clubfoot and its correlation with radiographic features abstract. Archives of Bone and Joint Surgery. 2017 May;5(3):168. -173.
4. Shah MQ, Khan A, Zardad MS, Iqbal R, Ahmed S. Ponseti technique for management of congenital idiopathic club foot. Journal of Ayub Medical College Abbottabad. 2017 Apr 8;29(2):246-9.
5. Khan NU, Askar Z, Hakeem A, Durrani Z, Ahmad I, Ayaz M, Khan FU. Idiopathic congenital clubfoot: our experience with the Ponseti method of treatment. Pak J Surg. 2010;26(1):70-4.
6. Gopakumar TS, Mohan R. Ponseti technique in the management of idiopathic club foot. Orthopaedics. 2014;15:17-22.

7. Ullah H, Siraj M, Ullah Z, Khan MS. Early Experience with Ponseti Technique in the Management of Congenital Idiopathic Talipes Equino Varus (CTEV) in Children Less Than 1 Year of Age. Journal of Pakistan Orthopaedic Association. 2015 Mar 2;27(2):27-28.
8. Lara LC, Neto DJ, Prado FR, Barreto AP. Treatment of idiopathic congenital clubfoot using the Ponseti method: ten years of experience. RevistaBrasileira de Ortopedia (English Edition). 2013 Jul 1;48(4):362-7.
9. Kumar R, Suman SK, Manjhi LB. Evaluation of outcome of treatment of idiopathic clubfoot by ponseti technique of manipulation and serial plaster casting. International Journal of Orthopaedics. 2017;3(4):23-7.
10. Azhar MM, Hussain S. Results of Ponseti Technique in Treatment of Idiopathic Club Foot Deformity Our Experience and Early Results. Pak J Med &Health Scie. 2015 Apr 1;9(2):530-4.
11. Scher DM, Feldman DS, van Bosse HJP, Sala DA, Lehman WB. Predicting the need for tenotomy in the Ponseti method for correction of clubfeet. J PediatrOrthop. 2004;24(4):349–52.
12. Saini R, Dhillon MS, Tripathy SK, Goyal T, Sudesh P, Gill SS, et al. Regeneration of the Achilles tendon after percutaneous tenotomy in infants: a clinical and MRI study. J PediatrOrthop B. 2010;19(4):344–7.
13. Aggarwal A, Gupta N. The Role of Pirani Scoring System in the Management and Outcome of Idiopathic Club Foot by Ponseti Method.International Journal of Science and Research.2016;5(6):84-7.
14. Cummings RJ, Davidson RS, Armstrong PF, Lehman WB. Congenital Clubfoot .J Bone Joint Surg 2002;84-A:290-308.
15. Kumar R, Suman SK, Manjhi LB. Evaluation of outcome of treatment of idiopathic clubfoot by ponseti technique of manipulation and serial plaster casting. Int J Ortho Sci. 2017:23-7.
16. Pulak S, Swamy MK. Treatment of idiopathic clubfoot by Ponseti technique of manipulation and serial plaster casting and its critical evaluation. Ethiopian J Health Sci.2012;22(2):20-5
17. Bhatiwal SK, Chopra BL, Khajotia BL, Chauhan S. Idiopathic clubfoot treated by Ponseti method: a series of 300 cases. Int J Resea Orthoaedics. 2018 Nov;4(6):954-60.
18. 86. Gunalan R, Mazelan A, Lee YP, Saw A. Pattern of presentation and outcome of short-term treatment for idiopathic clubfoot/CTEV with Ponseti method. J Malaysian Orthopaedic.2016 Nov;10(3):21-5.
19. Agarwal S, Suresh B, Mathew V. Functional outcome of tendoachilles following Ponseti's tenotomy for treatment of congenital talipes equinovarus in children older than two years. Int J Rese Orthopaedics. 2017 Sep;3(5):1057-61.
20. Rijal. Treatment of idiopathic clubfoot. Ponseti vs Kite method Ind J Ortho 2010; 44(2): 202-207.
21. Changulani M, Garg NK, Rajagopal TS, Boss A, Nayagam SN, Sampath J, Bruce CE. Treatment of idiopathic clubfoot using the Ponseti method. J Bone Joint Surg (Br) 2006; 88B: 1385-138.
22. Vinoth KR, Reddy VV. Idiopathic congenital talipes equino varus treated (ctev) by ponseti method. Int J Sci Research. 2019 Oct 3;8(9):70-3.
23. Herzenberg JE, Radler C, Bor N. Ponseti Versus Traditional Methods of casting for Idiopathic Clubfoot. J Pediatr Orthop 2002; 22(4):517-521.
24. Loof E. Additional challenges in children with idiopathic clubfoot: is it just the foot?. J children's Orthopaedics. 2019 Jun 1;13(3):245-51.
25. Malhotra R, Mohapatra A, Arora G, Choudhury P, Joshi H, Patel P. Ponseti technique for the management of congenital talipes equinovarus in a rural set-up in India: Experience of 356 patients. Children. 2018 Apr;5(4):49-55.
26. Docker C, Lewthwaite S, Kiely N. Ponseti treatment in the management of clubfoot deformity - a continuing role for paediatric orthopaedic services in secondary care centers. Ann R Coll Surg Engl 2007; 89: 510-512.
27. Barker SL, Lavy CBD. Correlation of clinical and ultrasonographic findings after Achillis tenotomy in idiopathic clubfoot. J Bone Joint Surg (Br) 2006; 88B: 377-379.
28. Faizan M, Jilani LZ, Abbas M, Zahid M, Asif N. Management of idiopathic clubfoot by Ponseti technique in children presenting after one year of age. J Foot and Ankle Surg.2015 Sep 1;54(5):967-72.
29. Digge V, Desai J, Das S. Expanded age indication for ponseti method for correction of congenital idiopathic talipes equinovarus: a systematic review. J Foot and Ankle Surg. 2018 Jan 1;57(1):155-8.
30. Dutta M, Kumar A, Chhabra A, Sahu VK Yadav V. To study the outcome of congenital talipes equinovarus by ponseti method. Int J Orthopaedics Sci 2018; 4(2): 316-323.
1. Agarwal S, Suresh B, Varghese M, Khanna V, Bajaj MS. Functional outcome of tendoachilles following Ponseti‘stenotomy for treatment of congenital talipes equino varus in children older than two years. Int J Res Orthop 2017;3:1057-61.
2. Gunalan R, Mazelan A, Lee YP, Saw A. Pattern of Presentation and Outcome of Short-term Treatment for Idiopathic Clubfoot/CTEV with Ponseti Method. Malaysian orthopaedic journal. 2016 Nov;10(3):21-5.
3. Baghdadi T, Bagheri N, Najafi A, Mansouri P, Farzan M. Ponseti casting method in idiopathic congenital clubfoot and its correlation with radiographic features abstract. Archives of Bone and Joint Surgery. 2017 May;5(3):168. -173.
4. Shah MQ, Khan A, Zardad MS, Iqbal R, Ahmed S. Ponseti technique for management of congenital idiopathic club foot. Journal of Ayub Medical College Abbottabad. 2017 Apr 8;29(2):246-9.
5. Khan NU, Askar Z, Hakeem A, Durrani Z, Ahmad I, Ayaz M, Khan FU. Idiopathic congenital clubfoot: our experience with the Ponseti method of treatment. Pak J Surg. 2010;26(1):70-4.
6. Gopakumar TS, Mohan R. Ponseti technique in the management of idiopathic club foot. Orthopaedics. 2014;15:17-22.

7. Ullah H, Siraj M, Ullah Z, Khan MS. Early Experience with Ponseti Technique in the Management of Congenital Idiopathic Talipes Equino Varus (CTEV) in Children Less Than 1 Year of Age. Journal of Pakistan Orthopaedic Association. 2015 Mar 2;27(2):27-28.
8. Lara LC, Neto DJ, Prado FR, Barreto AP. Treatment of idiopathic congenital clubfoot using the Ponseti method: ten years of experience. RevistaBrasileira de Ortopedia (English Edition). 2013 Jul 1;48(4):362-7.
9. Kumar R, Suman SK, Manjhi LB. Evaluation of outcome of treatment of idiopathic clubfoot by ponseti technique of manipulation and serial plaster casting. International Journal of Orthopaedics. 2017;3(4):23-7.
10. Azhar MM, Hussain S. Results of Ponseti Technique in Treatment of Idiopathic Club Foot Deformity Our Experience and Early Results. Pak J Med &Health Scie. 2015 Apr 1;9(2):530-4.
11. Scher DM, Feldman DS, van Bosse HJP, Sala DA, Lehman WB. Predicting the need for tenotomy in the Ponseti method for correction of clubfeet. J PediatrOrthop. 2004;24(4):349–52.
12. Saini R, Dhillon MS, Tripathy SK, Goyal T, Sudesh P, Gill SS, et al. Regeneration of the Achilles tendon after percutaneous tenotomy in infants: a clinical and MRI study. J PediatrOrthop B. 2010;19(4):344–7.
13. Aggarwal A, Gupta N. The Role of Pirani Scoring System in the Management and Outcome of Idiopathic Club Foot by Ponseti Method.International Journal of Science and Research.2016;5(6):84-7.
14. Cummings RJ, Davidson RS, Armstrong PF, Lehman WB. Congenital Clubfoot .J Bone Joint Surg 2002;84-A:290-308.
15. Kumar R, Suman SK, Manjhi LB. Evaluation of outcome of treatment of idiopathic clubfoot by ponseti technique of manipulation and serial plaster casting. Int J Ortho Sci. 2017:23-7.
16. Pulak S, Swamy MK. Treatment of idiopathic clubfoot by Ponseti technique of manipulation and serial plaster casting and its critical evaluation. Ethiopian J Health Sci.2012;22(2):20-5
17. Bhatiwal SK, Chopra BL, Khajotia BL, Chauhan S. Idiopathic clubfoot treated by Ponseti method: a series of 300 cases. Int J Resea Orthoaedics. 2018 Nov;4(6):954-60.
18. 86. Gunalan R, Mazelan A, Lee YP, Saw A. Pattern of presentation and outcome of short-term treatment for idiopathic clubfoot/CTEV with Ponseti method. J Malaysian Orthopaedic.2016 Nov;10(3):21-5.
19. Agarwal S, Suresh B, Mathew V. Functional outcome of tendoachilles following Ponseti's tenotomy for treatment of congenital talipes equinovarus in children older than two years. Int J Rese Orthopaedics. 2017 Sep;3(5):1057-61.
20. Rijal. Treatment of idiopathic clubfoot. Ponseti vs Kite method Ind J Ortho 2010; 44(2): 202-207.
21. Changulani M, Garg NK, Rajagopal TS, Boss A, Nayagam SN, Sampath J, Bruce CE. Treatment of idiopathic clubfoot using the Ponseti method. J Bone Joint Surg (Br) 2006; 88B: 1385-138.
22. Vinoth KR, Reddy VV. Idiopathic congenital talipes equino varus treated (ctev) by ponseti method. Int J Sci Research. 2019 Oct 3;8(9):70-3.
23. Herzenberg JE, Radler C, Bor N. Ponseti Versus Traditional Methods of casting for Idiopathic Clubfoot. J Pediatr Orthop 2002; 22(4):517-521.
24. Loof E. Additional challenges in children with idiopathic clubfoot: is it just the foot?. J children's Orthopaedics. 2019 Jun 1;13(3):245-51.
25. Malhotra R, Mohapatra A, Arora G, Choudhury P, Joshi H, Patel P. Ponseti technique for the management of congenital talipes equinovarus in a rural set-up in India: Experience of 356 patients. Children. 2018 Apr;5(4):49-55.
26. Docker C, Lewthwaite S, Kiely N. Ponseti treatment in the management of clubfoot deformity - a continuing role for paediatric orthopaedic services in secondary care centers. Ann R Coll Surg Engl 2007; 89: 510-512.
27. Barker SL, Lavy CBD. Correlation of clinical and ultrasonographic findings after Achillis tenotomy in idiopathic clubfoot. J Bone Joint Surg (Br) 2006; 88B: 377-379.
28. Faizan M, Jilani LZ, Abbas M, Zahid M, Asif N. Management of idiopathic clubfoot by Ponseti technique in children presenting after one year of age. J Foot and Ankle Surg.2015 Sep 1;54(5):967-72.
29. Digge V, Desai J, Das S. Expanded age indication for ponseti method for correction of congenital idiopathic talipes equinovarus: a systematic review. J Foot and Ankle Surg. 2018 Jan 1;57(1):155-8.
30. Dutta M, Kumar A, Chhabra A, Sahu VK Yadav V. To study the outcome of congenital talipes equinovarus by ponseti method. Int J Orthopaedics Sci 2018; 4(2): 316-323.

Most read articles by the same author(s)