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Outpatient Ponseti Management of Idiopathic Clubfoot in Infants: A Prospective Benchmark Study
G Prajwal1, Udit Agrawal2, B K Vaibhav2
1Department of Orthopaedics, CDSIMER, Kanakapura, Karnataka, India.
Background:
Idiopathic congenital talipes equinovarus is a common congenital foot deformity that may cause lifelong disability if treatment is delayed. Although the efficacy of the Ponseti method in early idiopathic clubfoot is well established, prospective outpatient data remain useful as a local benchmark against which future studies of delayed, recurrent, syndromic, or otherwise complex clubfoot can be compared.
Materials And Methods:
This prospective observational study was conducted from March 2021 to August 2022 at Basaweshwar Teaching and General Hospital attached to Mahadevappa Rampure Medical College, Kalaburagi, India. Children aged 7 days to 1 year with congenital idiopathic clubfoot were eligible. Children older than 1 year, syndromic or secondary clubfoot, associated congenital anomalies suggesting non-idiopathic deformity, and previous clubfoot surgery were excluded to create a clearly defined early idiopathic reference cohort. Serial Ponseti manipulation and above-knee casting were performed, with percutaneous Achilles tenotomy when residual equinus persisted. Pirani score, cast requirement, tenotomy, residual deformity, relapse, and 6-month follow-up were recorded.
Results:
Sixty-five children were screened; 15 were excluded, and 50 children with 66 clubfeet were analysed. Mean age was 3.72 (2.28) months; 40 children were male, and 16 had bilateral involvement. Mean Pirani score improved from 5.27 before treatment to 0.58 before equinus correction and 0.05 after the final cast, with maintenance at 6 months (P < 0.001). At final follow-up, 98% had no residual deformity and relapse occurred in 2%.
Conclusion:
Ponseti treatment produced reliable short-term correction of early idiopathic clubfoot in infants, with minimal surgical intervention. These findings should be interpreted as a reference outcome for routine early-presenting cases, while future research should focus on delayed, recurrent, syndromic, and secondary clubfoot where the treatment response may differ.