Abstract

Clubfeet with rigid equinus, severe plantarflexion of all the metatarsals, a transverse crease in the sole of the foot, short and hyperextended great toe, forefoot adduction and supination and a deep posterior crease are categorized under the heading of complex clubfeet, which do not respond to the conventional Ponseti technique. Rather treatment of such feet with conventional Ponseti method results in the development of secondary deformities and thus failure of treatment. Hence modification of the technique is warranted for optimal correction of these feet as described by Ponseti. The aim of our study was to evaluate effectiveness of Modified Ponseti technique in the management of complex clubfoot. Thirty two complex clubfeet in 19 patients were managed by Modified Ponseti technique through the study period. Four patients with 7 complex clubfeet were lost to follow-up. At the end of study 15 patients with 25 complex clubfeet were available for final follow up assessment and evaluation. Pirani and Dimeglio score was allotted to each foot at every visit. There after each foot was manipulated and casted as per the Modified Ponseti technique at an interval of one week. Average number of casts required for deformity correction was 7.68. Tendo-achilles tenotomy was obligatory in 23 (93.33 %) feet. The mean follow-up duration was 12.35 months (Range 8-21 months). The mean pre-treatment Pirani score (initial PS) was 5.60±0.54 and mean post-treatment Pirani score (PS at SFAB) was 0.70±0.38. The change in mean score post intervention was found to be statistically significant. The mean pre-treatment Dimeglio score (initial DS) was 15.80±2.02 and mean post-treatment Dimeglio score (DS at SFAB) was 3.68±1.35. The change in mean score post intervention was found to be statistically significant. Relapse rate was 4% (n=1), which responded to re-casting with modified Ponseti technique and re-tenotomy of the tendo-achilles. Based on our study results and existing literature we recommend modified Ponseti technique as the first line initial treatment for these complex feet. However such feet require higher number of plaster casts with higher rate of tendo-achilles tenotomy, with high relapse rate than their classical idiopathic counterparts, nonetheless the eventual outcome is reasonable correction of deformity, negating the necessity of multifaceted operating procedures.

Keywords

Complex clubfeet, Modified Ponseti method, Conventional Ponseti technique, Pirani score, Dimeglio score