Abstract: Background: The plan of studying CTEV correction was proposed as it is one of the common congenital orthopedic deformity with various available mode of treatment. Among available treatment modalities it was found that Ponseti method of manipulation is least invasive, easy to learn and highly effective. Under this impression project was proposed to study its effectiveness.
Aim: Aim of study was to evaluate the effectiveness of Ponseti technique of the plaster cast application in the management of CTEV.
Objectives: The objectives were to compare the effected limb with the normal limb (in unilateral cases), evaluate the Achilles tendon function and morphology after percutaneous tenotomy clinically and sonologically and to assess the recurrences of deformities.
Methodology: The study is Retrospective observational type of study carried out in the Department of Orthopedics with 20 patients diagnosed with CTEV (both unilateral and bilateral) who were treated at our centre from beginning. Pirani score at presentation was taken to quantify the severity of the deformity. The Ponseti Technique was used to correct this deformity. Percutaneous Tendo Achilles tenotomy was performed in those cases that had resistant equinus deformity. Dennis brown splint was offered to all the patients after complete correction. Ultrasound examination of the hip, vessels, Tendo Achilles was performed to check for underlying hip dysplasia, patency of vessels and for the continuity of Achilles tendon. The strength of the Peronei muscles was measured clinically.
Result: It was found that out of 20 patients under study contributing 27 feet, 15 were males and 5 were females. There was bilateral presentation in 7 patients and remaining 13 has unilateral deformity which was on left side in 9 and right side in 4 patients. One patient presented with amniotic band syndrome with right sided CTEV. The average Pirani’s score was 3.74/6. 13 patients showed a Pirani score of 4.5. In patients of unilateral CTEV there was variation in the sizes of foot where the effected foot was smaller than that of the normal with a mean difference of 0.45cms. Great toe shortening was noticed in 17 patients with no significant limb length difference. Ultrasound screening of the hip showed that all the hips were mature and stable with alpha angle being greater than 60 degrees. Ultrasound for the vascular status revealed no abnormality in the wave pattern of the vasculature of effected foot with the normal foot in unilateral cases. In the patient with congenital band syndrome, the peroneal artery was absent. The Tendo Achilles (TA) tendon regained continuity in all the patients that have undergone percutaneous TA tenotomy. Three patients showed recurrence of the deformity and all of them were found noncompliant with the Abduction Brace. These three patients needed surgery for the deformity that has recurred. One had under gone PMSTR; one need limited posterior release and one patient required Tibialis.
Conclusion: The study was about necessity to diagnose this deformity as early as possible, preferably in antenatal scans. As it helps the patient to seek early intervention for its correction. There are many existing anatomical alterations these all need to be evaluated further in future and their impact on CTEV correction, its relapse and performance of foot in future. The compliance to the abduction brace after correction is most important factor to prevent development of the relapse.
