COMPARISON OF ACCELERATED VS STANDARD PONSETI TECHNIQUE AMONG CHILDREN’S HAVING CONGENITAL TALIPES EQUINOVARUS
Keywords:Congenital Talipes Equinovarus, Ponseti technique, treatment, accelerated ponseti technique, standard, clubfoot
AbstractBackground: The resurgence and long duration of treatment of the Ponseti method in recent years has been punctuated by less than favourable long-term outcomes for surgically treated feet. Objectives of the study were to compare the two treatment techniques accelerated vs standard Ponseti technique among children’s having Congenital Talipes Equinovarus. Methods: This was two years randomized control trial study carried out among total 104 idiopathic congenital talipes equinovarus patients in Orthopaedics and Spine Unit, Hayatabad Medical Complex, Peshawar. A convenient sampling technique was used in this study. Informed written consent was taken from each respondent. Patients in group A was subjected to accelerated ponseti technique and patients in group B was subjected to standard ponseti technique. At one month after treatment, all the patients were re assessed on the basis of pirani score. Data was collected and analyzed using SPSS version 21. Results: This study included a total 104 clinically diagnosed Congenital Talipes Equinovarus patients with mean age 5.5±2.1 months and 52 in each treatment group. Out of total 104 patients 68 (65.4%) were male and 36 (34.6%) were female. They’re found significant difference in the mean ponseti scores of these two-group p=0.042 provided comparatively low mean pirani score in accelerated ponseti group. All female child in accelerated ponsati group was responded to the treatment with 100% effectiveness rate. The difference of effectiveness of treatment was significant p=0.015 for children age range 4–8 months divided in two treatment group with good effectiveness 80.8% in accelerated ponseti group. Conclusion: Accelerated ponseti technique is more effective than standard ponseti technique for Congenital Talipes Equinovarus.
Najdi H, Jawish R. Management of metatarsus adductus, bean-shaped foot, residual clubfoot adduction and Z-shaped foot in children, with conservative treatment and double column osteotomy of the first cuneiform and the cuboid. Int J Orthop 2015;2(6):438–44.
Pirani S, Hodges D, Sekeramayi F. A reliable & valid method of assessing the amount of deformity in the congenital clubfoot deformity. Orthop Proc 2008;90(Suppl 1):53.
Chu A, Lehman WB. Persistent clubfoot deformity following treatment by the Ponseti method. J Pediatr Orthop B 2012;21(1):40–6.
Culverwell A, Tapping C. Congenital talipes equinovarus in Papua New Guinea: a difficult yet potentially manageable situation. Int Orthop 2009;33(2):521–6.
Smythe T, Kuper H, Macleod D, Foster A, Lavy C. Birth prevalence of congenital talipes equinovarus in low‐and middle‐income countries: a systematic review and meta‐analysis. Trop Med Int Health 2017;22(3):269–85.
Spiegel DA, Shrestha OP, Sitoula P, Rajbhandary T, Bijukachhe B, Banskota AK. Ponseti method for untreated idiopathic clubfeet in Nepalese patients from 1 to 6 years of age. Clin Orthop Relat Res 2009;467(5):1164–70.
Murtaza K, Saleem Z, Malik S. Talipes equinovarus or Clubfoot: A review of study approaches, management and trends in Pakistan. Pak J Med Sci 2020;36(6):1414–20.
Ošťádal M, Lišková J, Hadraba D, Eckhardt A. Possible pathogenetic mechanisms and new therapeutic approaches of pes equinovarus. Physiol Res 2017;66(3):403–10.
Pulak S, Swamy M. Treatment of idiopathic clubfoot by ponseti technique of manipulation and serial plaster casting and its critical evaluation. Ethiop J Health Sci 2012;22(2):77–84.
Ahmad AA, Aker L. Accelerated Ponseti method: First experiences in a more convenient technique for patients with severe idiopathic club feet. Foot Ankle Surg 2020;26(3):254–7.
Krestyashin V, Vibornov D, Domarev A, Krestyashin I, Isakov A. About analgesia for infants during transcutaneous achillotomy at treatment of congenital clubfoot by ponseti method. Arch Euromedica 2016;6(1):13–5.
Harnett P, Freeman R, Harrison W, Brown L, Beckles V. An accelerated Ponseti versus the standard Ponseti method: a prospective randomised controlled trial. J Bone Joint Surg Br 2011;93(3):404–8.
Morcuende JA, Abbasi D, Dolan LA, Ponseti IV. Results of an accelerated Ponseti protocol for clubfoot. J Pediatr Orthop 2005;25(5):623–6.
Elgohary HS, Abulsaad M. Traditional and accelerated Ponseti technique: a comparative study. Eur J Orthop Surg Traumatol 2015;25(5):949–53.
Ganesan B, Luximon A, Al-Jumaily A, Balasankar SK, Naik GR. Ponseti method in the management of clubfoot under 2 years of age: A systematic review. PLoS One 2017;12(6):e0178299.
Sutcliffe A, Vaea K, Poulivaati J, Evans AM. Fast casts’: Evidence based and clinical considerations for rapid Ponseti method. Foot Ankle Online J 2013;6(9):2.
Ahmad MN, Ghani A, Singh R, Bhatt MF, Shabir SA, Nisar K, et al. Comparative Study of Accelerated Ponseti Cast with Standard Ponseti Cast. J Med Sci Clin Res 2020;8(2):388–92.