Assessing the factors that influence a recurrence of congenital talipes equinovarus in children treated with the Ponseti method
Keywords:Congenital talipes equinovarus, Clubfoot, Ponseti technique, Pirani score, Serial cast
Background: Congenital talipes equinovarus, also known as clubfoot, is one of the most common congenital malformations in pediatric orthopedics. With a checkered treatment history extending from Hippocrates' bandages to Kite's serial plaster cast application to surgical treatment, no single modality can claim to be a complete treatment.
Methods: In a combined prospective and retrospective study at the Department of Orthopaedics of St. Stephen's Hospital, 192 patients with 292 clubfeet who met the inclusion criteria and received ethics committee approval were included. The purpose of the research was to identify early recurrence characteristics, undertake the Pirani scoring, and identify additional clinical characteristics to evaluate recurrence predictors.
Results: In our study, out of 192 patients, 188 were successfully treated with the Ponseti casting technique combined with tendoachilles tenotomy; tenotomy was required in 177 patients (93%). Four patients were lost to follow-up. Nine out of sixty-one children in the six-month-to-one-year age group showed the maximum rate of recurrence (15%). The mean number of cast applications was 7.23. In all, 90% of children required casts ranging from four to eight in number. The syndromic association was seen in 10.4% of cases with club feet. Most common among them were neural tube defects (4.2%) and arthrogryposis (3% of cases). Fourteen out of 154 (or 9%) of the non-operated idiopathic patients had lateral border recurrence during an average follow-up of two years. According to the Pirani score, recurrence was seen in eight out of twenty (or 40% of) syndromic patients and five out of fourteen (or 35% of) operated cases. In 37% of recurrences, dynamic supination was observed.
Conclusions: Even though Ponseti's approach to treating idiopathic clubfoot is widely regarded as the gold standard, recurrences are known to occur even in the best of circumstances. The most common cause of recurrence was poor brace compliance, with families citing a variety of reasons.
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