Abstract: Background: Mid-term success results by Ponseti method for the treatment of neglected clubfoot can lead to a renewed interest among pediatric orthopedic surgeons. The purpose of this study was to evaluate mid-term effectiveness of Ponseti method for the treatment of neglected congenital idiopathic clubfoot.
Methodology: A total of 49 patients (67 clubfeet) were treated by Ponseti method and were studied prospectively up to July 10 (mean follow up period 5 years, minimum follow-up period of 3 years). Age at the initiation of the treatment, gender, bilaterality, severity of the initial clubfoot deformity measured by Pirani Severity Score System, total numbers of Ponseti casts before the tenotomy, details of tenotomy, compliance with brace and CTEV shoes were examined. Passive range of movements and look of club foot are evaluated with mean 5 years follow-up.
Results: We applied the Ponseti method and found good to excellent results in 44 patients - 89.79% (58 clubfeet - 86.56%) at mean five year of follow up. Parents of 32 patients (65.30%) accepted the look of the clubfoot nearly normal and parents of 12 patients (24.49%) accepted the look of clubfoot as normal. Of the 49 patients who responded to initial Ponseti casting, 14 patients - 28.57% (19 clubfeet - 28.35%) had relapse at varying age; out of which 9 patients - 64.29% (10 clubfeet - 52.63%) were corrected by Ponseti casting method, while 5 patients - 35.71% (9 clubfeet - 47.37%) were resistant to Ponseti method. Poor compliance with the Denis Browne splint was thought to be the main cause of failure in these patients.
Conclusion: Ponseti treatment for neglected CTEV has had encouraging results in terms of attaining a functional and visually acceptable foot and lessening the extent of surgery in cases where full correction is not achieved.
