Ponseti Technique in clubfoot treatment, tertiary center in Riyadh, Saudi Arabia

Abstract

Background: Congenital Talipes Equino Varus (CTEV) is a common congenital foot deformity that is associated with long term disability. Treatment with Ponseti method has been successful especially for children who present early. We conducted this study between June 2008 and August 2019 at the King Abdulaziz Medical city, Riyadh and it was conducted to investigate the patterns of clubfoot deformity and adherence to ponseti treatment protocol among children with clubfoot deformity and to report the early and late outcome.
Methods: It was a retrospective study from one single tertiary institute and all patients were treated with the same surgeon. A total of 93 rigid club foot, age between 1 day to 5 years of both male and female were selected purposively to conduct this study. Face-to face interview method was adopted by using semi-structured questionnaire.
Results: Most of the children were boys. More than two third (69.7%) were in the age group less than 12 months. Study found 41 (44.1%) of our sample presented with both feet deformity, 29 (31.2%) had only right foot deformity and the rest of 23 (24.7%) presented only with left foot deformity. (76.3%) of our sample had typical idiopathic clubfoot deformity. The rest of 15.1%(14) and 8.6%(8) had neurogenic and Syndromatic underlying pathology respectively. The mean number of castings was 5 and mean duration of casting was 9 weeks. Majority (81.7%) of the parents were fairly adherent to the Ponseti protocol, where 18.3% reported poor compliance to the instructions for deferent reasons. The initial success rate of 97.9% was reached, with two feet (2.1%) diagnosed as a resistant clubfoot and eventually required posteromedial soft tissue surgery. With mean follow up of 39.1 months. 6 feet (4.4%) developed relapse but were treated with repeated Ponseti method, while 3.7%(5) required re-do TAL , and 3 feet(2.2%) developed late dynamic supination and was corrected by Tibialis Anterior Tendon Transfer to lateral Cuniform bone.
Conclusion: This study presents patients with Congenital Talipes Equino Varus (CTEV) deformity which was successfully managed by Ponseti Protocol. Many CTEV patients still present late for treatment. However, the Ponseti method remained very effective with very high initial success rate of 97.9%. Relapsed CTEV can still be treated successfully with repeat casting using the Ponseti method. Strict adherence to the Ponseti recommendations by both treating physician and parents is the golden key to the best final success rate.