Easy Cast Removal in Idiopathic Congenital Talipes Equinovarus: A Study on Modified Ponseti Technique using an...

Congenital talipes equinovarus (CTEV), or clubfoot, is a common congenital deformity treated effectively using the Ponseti method. However, conventional cast removal techniques, such as oscillating saws or water soaking, can be uncomfortable, time-consuming, and impractical in resource-limited settings. This study evaluated a novel modification involving the interposition of a sterile polythene sheet between layers of plaster of Paris to facilitate easier, safer, and faster cast removal.

In this prospective observational study conducted from December 2024 to May 2025 at a tertiary care hospital in Central India, 20 patients (24 feet) with idiopathic CTEV underwent Ponseti casting with the polyethylene modification. Outcome measures included the number of casts, need for tenotomy, correction rate, cast removal time, complications, relapse rate, and caregiver satisfaction assessed via a 5-point Likert scale. Statistical analysis was performed using the Chi-square and Fisher's exact test.

The average number of casts required per foot was 5.4 ± 1.1. Achilles tenotomy was performed in 70.8% of cases. Full correction was achieved in 91.7% of feet, and relapse occurred in 4.2%, managed with repeat casting. Mean cast removal time was 3.4 ± 0.6 min without the use of specialized tools. Minor complications (e.g., cast slippage and skin irritation) were observed in 15% of feet. Parental satisfaction was high in 55% of cases, with a significant association between relapse and low satisfaction (P = 0.03).

The inclusion of a sterile polythene layer in the Ponseti cast offers a simple, cost-effective modification that facilitates rapid, safe cast removal without compromising treatment efficacy. This approach may be particularly advantageous in high-volume or resource-constrained orthopedic settings.