Ponseti Method in the Management of Syndromic and Arthrogrypotic Clubfoot: Outcome of Treatment in Iraqi Patients

BACKGROUND:
Clubfoot is one of the most common congenital birth defects, most occuras an isolated birth defect and are considered idiopathic. The Ponseti method of serial casting has gained widespread popularity in recent years for the treatment of idiopathic clubfoot.Non-idiopathic clubfeet are thought to be too rigid to correct by casting alone, it is often treated primarily with surgical extensiveSoft tissuereleases, and the use of Ponseti method for the treatment of non-idiopathic clubfoot has not been extensively reported.
AIM OF THE STUDY:
To study the effectiveness of Ponseti method to achieve correction in non-idiopathic clubfoot, and to follow the patient for relapses.
PATIENTS AND METHOD:
During the period from February 2013 to December 2017, 16 infants with clubfeet associated with other congenital deformities were managed by Ponseti method, and followed for a minimum of 10 months and maximum of 60 months (mean ± SD= 32.94±17.39 ). All patients were treated at medical city center in Baghdad/Iraq.
RESULTS:
16 patients with syndromic clubfoot, 9 of them diagnosed as arthrogryposis and the rest as other syndromic types. 12 of them were males(75.0%) and 4 of them were females (25.0%). 14 of cases had bilateral deformities (87.5%) and 2 unilateral deformities (12.5%).5 patients required 4- 5 casts to achieve initial correction (31.2%) and 11 patients required 6-8 (68.8%).In arthrogryposis only 55.6% of cases required 5 and more casting, while in other syndromic cases 85.7% of cases required 5 and more casting. All patients required additional minor surgical procedures. Initial Pirani score of pre casting to the right and left was (mean±SD) 4.83±0.81 and 5.03±0.85 respectively, Pirani score after removal of final cast(pre surgery) to the right and left was (mean±SD) 1.03±0.74 and 1.3±0.7 respectively (p –value ˂ 0.001).Follow-up for minimum 10 months and maximum 60 months (mean±SD/ 32.94±17.39) .Half of our patients got plantigrade, pain free, and flexible foot at last follow up with no relapse, another half of patients developed relapse at subsequent follow up. Most relapses occurred in arthrogryposis cases (66.7%),while in other syndromic cases relapses occurred in (28.6%).Two of relapsing cases(25%) treated by repeated casting, another two cases(25%) treated by repeated casting and heel cord release, and four cases (50%) treated by salvage procedure (talectomy) after failed repeated casting due to rigid and stiff feet.
CONCLUSION:
The Ponseti method is effective treatment for syndromic clubfootto achieve flexible, pain free and plantigrade foot and to minimize the extensive future surgeries.

Keywords:

Syndromic Clubfoot

Ponseti method

Outcome of treatment

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