CTEV CORRECTION BY PONSETTI TECHNIQUE

INTRODUCTION

The congenital talipes equinovarus (CTEV) or clubfoot is one of the most common and complex congenital deformities. The incidence of idiopathic clubfoot is estimated to be 1 to 2 per 1,000 live births. The deformity has four components: ankle equinus, hindfoot varus, forefoot adductus, and midfoot cavus. The goal of the treatment is to correct all the components of clubfoot to obtain painless, plantigrade, pliable and cosmetically and functionally acceptable foot within the minimum time duration with least interruption of the socioeconomical life of the parent and child.

There is nearly universal agreement that the initial treatment of the clubfoot should be non-operative regardless of the severity of the deformity. If there is no improvement, then most of the surgeons prefer postero-medial release (PMR) of the soft tissue. The primary disadvantages of PMR are high complication and recurrence (13-50%) rate and the difficulty of treating recurrences.Most of the authors have concluded that extensive surgery is not the right approach to the management of CTEV. Over the past two decades, more and more success has been achieved in correcting CTEV without the need for surgery by Ponseti casting technique, which has become a gold standard worldwide. It includes serial corrective manipulation, a specific technique of the serial application of plaster cast supported by limited operative intervention (percutaneous Achilles tenotomy) The method has been reported to have success rate approaching 90- 96% in short, mid and long-term results.

The Ponseti casting technique of club foot management has been shown to be effective, producing better results and fewer complications than traditional surgical methods. In recent years, interest has been renewed in the Ponseti casting technique, and many centers now believe that most clubfeet can be treated by Ponseti casting technique rather than surgery. Ponseti casting technique is especially important in developing countries, where operative facilities are not available in the remote areas. The physicians and personnel trained in this technique can manage the cases effectively with the cast treatment only.

MATERIALS AND METHODS

This is a prospective observational study, conducted in a tertiary hospital. The study period was from July 2010 to December 2011. All the neonates with CTEV presented to the Department of Pediatric Surgery were treated according to the Ponseti casting technique. Neonates with clubfeet associated with meningocele, meningomyelocele, arthrogryposis multiplex congenita and other neuromuscular causes were excluded. A prior approval was taken from the Institutional Review Board. An informed written consent was taken from all parents. All relevant data were collected from each participants using predesigned data sheet that included patient’s demography, physical examination, management, which included Pirani severity scoring score (for initial assessment of the severity, and for evaluation of the feet after each component of the treatment and ultimate final outcome), total number of the casts applied before tenotomy, pre and post procedure complications like plaster sore, skin excoriation, blister formation, excessive bleeding following tenotomy or any other complication.