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Multidisciplinary management of clubfeet using the Ponseti method in a district general hospital setting

Rebecca Kampa1, Katherine Binks, Mia Dunkley

  • 1Department of Orthopaedics, Royal Surrey County Hospital, Egerton Road, Guildford, GU2 7XX, UK, bexkampa@doctors.org.uk.

Journal of Children'S Orthopaedics
|March 25, 2009
PubMed

Insights

Physiotherapist-led Ponseti method services in district hospitals successfully treat idiopathic congenital talipes equinovarus (CTEV). This approach achieves high correction rates, with most cases managed without surgery.

Area of Science:

  • Orthopedics
  • Pediatric Orthopedics
  • Physiotherapy

Background:

  • Idiopathic congenital talipes equinovarus (CTEV) is a common foot deformity.
  • The Ponseti method is a standard, effective treatment for CTEV.
  • Current practice often confines Ponseti method administration to specialist centers.

Purpose of the Study:

  • To evaluate the efficacy of the Ponseti method administered by non-medical specialists.
  • To assess the feasibility of delivering Ponseti services outside of specialist or teaching hospitals.

Main Methods:

  • Retrospective review of 24 children (39 feet) with idiopathic CTEV.
  • Treatment was managed by a physiotherapist-led service in a district general hospital setting.
  • Pirani scores were used to assess deformity severity.

Main Results:

  • Successful initial correction was achieved in 95% of feet.
  • 18 feet (46%) required Achilles tenotomy.
  • Average cast changes were 3.4 for non-tenotomy and 7.5 for tenotomy groups.
  • Relapse occurred in 5% of cases, managed with serial casting.
  • No patients required open surgical release.

Conclusions:

  • A combined consultant/physiotherapist-delivered Ponseti service is effective in district general hospitals.
  • This model demonstrates successful management of CTEV outside specialist settings.
  • Decentralizing Ponseti services can improve accessibility and outcomes for children with CTEV.
Abstract

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