Treatment of Idiopathic Clubfoot by Ponseti Technique of Manipulation and Serial Plaster Casting and Its Critical Evaluation

BACKGROUND Clubfoot has from long been an unsolved clinical challenge for the orthopedic surgeons. It is one of the commonest congenital deformities in children. More than 100,000 babies are born worldwide each year with congenital clubfoot. Around 80% of the cases occur in developing nations. METHODS Fifty three feet [mean Pirani score (total) 5.6] in 40 children were treated by the Ponseti method from June 2006 to December 2010. A prospective follow-up for a mean duration of 19.5 months (range 6-30 months) was undertaken. Evaluation of the deformity by Pirani score and goniometry was performed, before and after the treatment and the results were assessed through Wilcoxon signed rank test. RESULTS The average number of casts applied before full correction was 4.9. The duration of casts for more than 85% feet was <7 weeks. 94.3% patients needed tenotomy before full correction. There was a significant difference in the pre-treatment and the post-treatment Pirani score and goniometry values. CONCLUSION Ponseti method of manipulation and plaster casting is very effective in correcting clubfoot deformity. It is especially important in developing countries and well-trained physicians and health personnel can manage the cases effectively by manipulation and cast application.