A prospective cohort study on comparison of early outcome of classical Ponseti and modified Ponseti post tenotomy in clubfoot management

摘要

Introduction Ponseti method has become the main treatment modality for the management of clubfoot producing good long-term results. However, variation in cast application post tenotomy has not been evaluated. Methods A prospective cohort study involving 40 patients with 67 clubfeet were randomized into two groups: 32 above knee cast (AKC) and 35 below knee cast (BKC) after percutaneous tenotomy. All had foot abduction brace after post tenotomy cast. The median age was 21 weeks (range: 1–104 weeks) and 1.9:1 male/female ratio. 27 (67.5%) patients had bilateral clubfoot and unilateral in 13 (32.5%). Patients were followed-up for 6 months with documentation of the Pirani Score and the cost of treatment. Results No significant difference between AKC and BKC mean Pirani score before treatment (p?=?0.550) and after treatment (p?=?0.702). However, mean Pirani score at 6 months was significantly different (p?=?0.038). Overall mean number of casting was 6.4 in AKC group and 4.7 in BKC group (p?=?0.003). There was recurrence in 2 feet before completion of treatment (6.3%) among AKC and none among BKC group. However, there was no recurrence at 6 months after treatment in both groups. The mean cost for AKC and BKC were ?10,427.34 (52.33 US dollars) and ?7021.54 (35.24 US dollars) respectively (p?=?0.002). Conclusion Early results of below knee cast after tenotomy were comparable to the classical above knee cast after tenotomy in Ponseti treatment protocol for clubfoot. There was also reduction in cost of treatment in the modified Ponseti compared to the classical Ponseti. Long-term result will be desirable. Highlights ? A prospective study of idiopathic congenital talipes equinovarus at a University Teaching Hospitals Complex. Forty patients were recruited, all below the age of two years but with median age of 12 weeks and male to female ratio of 1.9:1. Twenty seven of the patients had bilateral clubfoot while thirteen had unilateral clubfoot amounting to 67 clubfeet considered. ? All the patients were evaluated at the Ponseti clinic and treatment commenced for them based on Ponseti treatment protocol. They all had serial manipulation and above knee casting to correct the cavus, adduction, varus deformities in that order. The last deformity to be corrected was equinus which required percutaneous Achilles tenotomy before above knee cast for three weeks. ? The patients at this stage were randomized into two group: above knee cast after tenotomy which is the control group that followed the classical Ponseti treatment protocol and below knee cast after tenotomy which was the study group. The parameters considered in them were the Pirani score before, after and at 6months after treatment and the cost differentials. Thirty two feet were in the control group while thirty five feet were in the study group. Early result showed that below knee cast after tenotomy was comparable to the classical Ponseti treatment and cost difference was significant.