Abstract: Specific Objectives:
Congenital talipes Equinovarus (clubfoot) is one of the most common foot Anomalies which can be treated by serial casting technique with high rate of success. Surgery is indicated for deformities that do not respond to conservative treatment or the patients that seek medical intervention too late or neglected by family without medical treatment. In our study, we reviewed the result of our newer modified technique for treatment of idiopathic clubfoot deformity with combination of modified ponseti casting and posteromedial soft tissue release in 6 month to 5year age group children.
Material and methods: Between May 2015 to May 2016, we treated twenty (20) feet with idiopathic CTEV in sixteen (16) children who were between 6 month to 5year age-group who were evaluated by Pirani scoring system before and after our newer modified technique for treatment of idiopathic clubfoot deformity. All the feet were given a trial of serial manipulation and cast application with 15 days interval with 4 to 5 number of CTEV cast then postero-medial soft tissue release was done with single incision and full correction achieved. Sutures were removed after 15 days followed by manipulation and cast application. postoperative cast immobilisation continue for 2 months in over corrected position or age more than 9 month old children given walking modified fibre CTEV cast and mobilisation with ‘Babagadi’ for 2 month in over corrected position. Our modified walking fibre CTEV cast change in 15 day interval with corrected position and mobilisation done atleast for 2 -3 month then we were made CTEV over corrected specialized shoes in which we were adviced. Patient to walk with CTEV shoes in day time and rest of night sleeping time. At the end of 6 and 12 months all feet were evaluated according to pirani Scoring system.
Results: All 20 feets were treated between 6 month to 60 months age-group children with mean age of 28months. Postoperatively the patients were followed up for a minimum of 6 month to maximum 18 months with mean of 12months. Post operative evaluation was done according to total score obtained by pirani scoring system. According to this 14 feet evaluated as pirani score 5.5, 4 feet b/w 5.5 to 4.5, 2 feet b/w 4 – 4.5. NO any patients had residual deformity, no any patients had relapse.
Conclusion: The timing of surgery did not change the final outcome considerably below 5 years of age in clubfeet. With our new modified technique for treatment of idiopathic clubfoot deformity with combination of modified ponseti casting and postero-medial soft-tissue release in 6 month to 5year age-group children. 95 percent of cases had excellent to good results. In our modified technique had chances of relepse and retained residual deformity are less. Relepses did not occur in one and half year follow up period. Our new technique had better functional outcome with faster recovery to other mode of treatment.