Effect of age at presentation on short term outcome of the ponseti method in the management of congenital talipes equinovarus

Abstract

ABSTRACT Congenital talipes equinovarus (CTEV) also known as clubfoot is one of the most common congenital conditions presenting at the paediatric orthopaedic clinics at MOI and CCBRT. Historically the treatment of clubfoot evolved from gentle manipulation to aggressive forced manipulation and finally radical surgeries with evidence of unfavourable outcome. Currently non-operative management with the Ponseti method is advocated and has shown high success rates. The age factor has been shown by most authors to have no significant effect on treatment but some still think otherwise. Objective:. The main aim of this study was to look into the effect of the initial age of presentation at the clinic on short term treatment outcome of the Ponseti method among patients with CTEV. Methodology: A prospective, descriptive cross sectional study, was conducted at MOI-paediatric orthopaedic clinic and CCBRT hospital in April 2013-March 2014. 170 children met the inclusion criteria and were enrolled. Children were studied from the beginning of treatment to when they had achieved correction by manipulation and casting sufficiently to require Steenbeek foot abduction brace or tenotomy and a final cast. Data was collected using a structured questionnaire and a validated assessment tool then coded, entered and analysed using SPSS version 16 program. Results: 75.9% of children seen were 0-6 months of age, their ages ranged from 1 week to 48months old. The male to female patients ratio was 1.6:1. The distribution of bilateral and unilateral cases was 47.1% by 52.9% respectively. Overall success rate with the Ponseti treatment in manipulation and casting was 99.4%, 42.9% required tenotomy and one patient needed extensive soft tissue release. Majority of patients (79.2%), below 25 months of age achieved correction faster, 1-5 castings, compared to children 25months and above. Conclusion: The success rate with Ponseti treatment among all age groups was high The age at initial treatment favours good short term outcome with the Ponseti method of treatment of clubfoot with fewer sessions of manipulation and castings.