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Ponseti technique of correcting idiopathic clubfoot deformity
N C Mkandawire1, E Chipofya1, G Likoleche1
1Department of Surgery, Queen Elizabeth Central Hospital and College of Medicine, Blantyre, Malawi.
Insights
The Ponseti method effectively treats clubfoot in children, achieving high correction rates and reducing the need for surgery. This conservative approach is now standard care.
Area of Science:
- Orthopedics
- Pediatric Orthopedics
- Pediatric Surgery
Background:
- Clubfoot is a common congenital deformity requiring effective treatment.
- The Ponseti method offers a non-surgical approach to clubfoot correction.
- Assessing the Ponseti method's efficacy at Queen Elizabeth Central Hospital (QECH) is crucial for its implementation.
Purpose of the Study:
- To analyze the efficacy of the Ponseti method for treating clubfoot at QECH.
- To compare the outcomes of the Ponseti method in different patient groups.
- To evaluate the impact of the Ponseti method on surgical interventions for clubfoot.
Main Methods:
- Prospective and consecutive enrollment of 91 patients with clubfoot from December 2000 to December 2001.
- Categorization of patients into three groups: primary idiopathic, complex idiopathic, and associated with congenital anomalies.
- Analysis of treatment duration, correction rates, and recurrence based on the Ponseti method's application.
Main Results:
- In previously untreated idiopathic clubfeet (Group 1), 84% achieved correction with the Ponseti method.
- For complex idiopathic clubfeet previously treated (Group 2), the Ponseti method achieved correction in all treated patients.
- Clubfeet associated with congenital anomalies (Group 3) showed lower initial correction rates and higher recurrence.
- The adoption of the Ponseti method led to a significant decrease in surgical procedures for clubfoot at QECH.
Conclusions:
- The Ponseti method is highly effective for treating primary idiopathic clubfoot.
- It provides successful correction for complex and previously treated clubfeet.
- The method significantly reduces the need for invasive surgical treatments, establishing it as standard care nationwide.
Abstract:
The efficacy of the Ponseti method of clubfoot treatment at Queen Elizabeth Central Hospital (QECH) was analysed from December 2000 to December 2001. Ninety one patients, 60 boys and 31 girls were prospectively and consecutively enrolled. 31 patients had a unilateral clubfoot and 60 had bilateral clubfeet. 77 patients had primary idiopathic clubfoot and 14 patients had clubfeet associated with other congenital anomalies such as arthrogryposis. 32 patients (35%) were lost to follow up; records were inadequate for 6 patients leaving 54 patients (59%) available for analysis. Three main groups were assessed. Group 1 (24 patients): virgin previously untreated primary idiopathic clubfeet: Ponseti method used from outset. Group 2 (19 patients): complex, primary idiopathic clubfeet: Ponseti method introduced after other manipulation techniques. Group 3 (11 patients): clubfeet associated with other congenital anomalies. In group 1, the mean age at start of treatment was 9.7 weeks and the mean time to correction of deformity was 7.4 weeks. 20 out of 24 patients (84%) had correction of deformity and remained corrected. 4 patients had recurrence of deformity mainly due to non compliance with treatment and correction was achieved once treatment restarted. In group 2, 19 patients had been on treatment for a mean period of 32 weeks prior to commencement of Ponseti treatment. In 17 of these patients the deformity was still uncorrected. Ponseti treatment was commenced at a mean age of 36 weeks and correction was achieved in all 17 patients after a mean treatment duration of 7.1 weeks. In group 3, correction of deformity was initially achieved in only 60%. The period to achieve correction was long and incidence of recurrence of deformity was high. The success of conservative treatment of clubfeet using the Ponseti method has resulted in large decrease in the number of surgical procedures performed under general anaesthaesia such as posteromedial releases in the treatment of clubfeet at QECH. This method has now been adopted as the Standard treatment of clubfoot and is being advocated nationwide.
