IDIOPATHIC CONGENITAL TALIPES EQUINO VARUS: PREDICTORS OF OUTCOME WHEN USING PONSETI METHOD

Abstract

Background and aims of the study: Identifying risk factors for poor outcome, is an important issue in the management of idiopathic congenital talipes equino varus foot deformity using Ponsetti Method.

Material & Methods: 198 feet of idiopathic congenital talipes equino varus foot deformity in 126 children, were treated using the Ponseti technique. They were followed up for a maximum of 36 months.

Patient prenatal, natal and family history were documented. Pre and post intervention morphologic measures were recorded. All cases had thorough clinical examination to exclude cases other than idiopathic congenital talipes equino varus, identified syndromes were excluded. Serial weekly plaster casting to correct cavus adducts and varus, followed by heel cord tenotomy if needed. Then foot abduction brace was used. results were graded as fully plantigrade(good), not fully plantigrade (fair) and relapsed (poor).

Results: The mean follow up was 19.9 + 5 months, 14 children 22 (11.1%) feet failed to show up at last follow up. Mean age at presentation was 56 + 143.6 days (1 day to 4 years). 112 children with 176 feet showed up at last follow up. 84 (75%)were males and 28 were females 12.5% had a similar condition in the family, positive consanguinity was in 35.7%. 31.2% were delivered by Caesarian section. The average number of casts was 8.2 for each foot, 14 (7.9%) had no tenotomy, all feet were corrected. 22 (12.5%) relapsed and recasted, 11 (6.2%) feet had retenotomies. In 18 (10.2%) feet (13 children) the parents refused the Ponseti management and under went open surgical releases else were. 21.4% of parents were compliant with abduction splint. In the surgical group 3 feet (16.6%) had a good result, 11 (61.1%) fair and 4 feet (22.2%) poor, 1 (5.5%) foot had residual metatarsus adducts. In the Ponseti managed group of (158 feet), 95 feet (60.1%) were good, 54 feet (34.2%) were fair and 9 feet (5.7%) poor, 21 (13.3%) feet had residual metatarsus adducts. Caesarian section (p=0.71), consanguinity (p=0.864), positive family history (p=0.12), sidedness (p=0.12) and age at presentation (p=0.52) had no bearing on results.

Conclusion: Parents’ compliance and devotion is a key factor for the successes of the technique.