Abstract
Aim
Kite manipulation and casting for congenital talipes equinovarus (CTEV) was noted to require a subsequent posteromedial release (PMR) in almost all of the children treated, with variable outcomes including overcorrection and stiffness. Introduction of the Ponseti serial manipulation and casting technique dramatically reduced the need for PMR. This study assesses the medium term outcomes in these two treatment groups.
Methods
We retrospectively identified patients treated for idiopathic CTEV between 1997 and 2007 under a single surgeon. Two cohorts with a minimum 4 years' follow-up were treated with Kite (1997–2001) and Ponseti (2002–2007) manipulation and casting. The entire Kite cohort (14 patients) and none of the Ponseti cohort (16 patients) required PMR. All patients were assessed by clinical and functional examination, questionnaire and medical notes review. There was a total of 40 feet (10 bilateral and 20 unilateral) with 20 feet in each cohort.
Results
7 feet (35%) in each cohort required further surgical procedures. Of these, 6 feet in the Kite/PMR group required bony surgical correction compared with none in the Ponseti group. There was a significant difference between the Kite/PMR and Ponseti groups in; calf circumference difference (mean 24mm vs 13mm p<0.05), subtalar movement (mean 15° vs 25° p<0.05), and ankle plantar flexion (mean 20° vs 45° p<0.05). There were also functional differences between the two cohorts (Kite/PMR vs Ponseti) with regard to; being very satisfied with the outcome (55% vs 95%), never limiting activities (50% vs 95%), never painful (60% vs 95%), and the ability to toe walk (35% vs 100%).
Conclusions
Since the introduction of the Ponseti method for treating CTEV in our unit, the outcome for children with this condition has improved significantly with regard to function, cosmesis and a greatly reduced risk of further surgical intervention.
