Results of Modified Ponseti Technique in Difficult Clubfoot and a review of literature

Ankur Agarwal; Sumit Gupta; Alok Sud; Sheetal Agarwal

doi:10.1016/j.jcot.2019.05.003

Results of Modified Ponseti Technique in Difficult Clubfoot and a review of literature

J Clin Orthop Trauma. 2020 Mar-Apr;11(2):222-231. doi: 10.1016/j.jcot.2019.05.003. Epub 2019 May 7.

Authors

Ankur Agarwal¹, Sumit Gupta², Alok Sud², Sheetal Agarwal³

Affiliations

¹ Department of Orthopaedics, Superspecialty Pediatric Hospital & Postgraduate Teaching Institute, Noida, India.
² Department of Orthopaedics, Lady Hardinge Medical College, New Delhi, India.
³ Department of Pediatrics, PGIMER & RML Hospital, New Delhi, India.

Abstract

Introduction: Serial Ponseti casting achieves deformity correction in early presenting idiopathic clubfoot cases normally in around 7 casts. However, there are resistant patients where correction requires more casts than usual. In such patients a modification in standard technique might be required right from the beginning. Such patients were collectively called as difficult clubfoot. The aim of this study was to assess the outcome of our modification to Ponseti technique in difficult clubfoot.

Methods: All idiopathic clubfoot cases who were 75th percentile or more in WHO age for weight chart (chubby infants) or untreated clubfoot patients presenting for first time to our clinic at more than 5 months age (late presenters and neglected cases) were included in the study. Patients who had been previously surgically intervened elsewhere, patients over 7 years of age, patients with syndromic clubfoot or clubfoot associated with neurological conditions were excluded from the study. The patients were treated by early tenotomy of tendoachillis and a plantar fascia release before starting serial casting by Ponseti technique. Post correction, strict bracing protocol was followed with regular follow up. Pirani scoring was done at each stage. Measurement of Talocalcaneal angle on AP radiograph, maximum degree of abduction and dorsiflexion was noted once every year.

Results: There were total 28 patients in our study. In all, 47 feet were subjected to modified Ponseti protocol. There were 21 male patients. Median age at presentation was 4 months. Mean centile of weight for age as per WHO growth chart was 64. Mean Pirani score at presentation was 5.86 (S.D. ± 0.34). Mean number of casts required for correction was 3.75 ± 1.10. Maximum followup period was 25 months.

Conclusion: This modification of Ponseti casting for difficult clubfoot patients achieves correction in shorter duration with less number of casts.

Keywords: Chubby infants; Difficult clubfoot; Late presenters; Modified ponseti technique; Neglected clubfoot.