Cross-sectional descriptive study of characteristics of infants with congenital talipes equino varus requiring and not requiring tendo-Achilles tenotomy post Ponseti casting
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20253418Keywords:
Congenital talipes equinovarus, Clubfoot, Ponseti method, Achilles tenotomy, Pirani score, Serial casting, Pediatric orthopedics, Treatment outcomesAbstract
Background: Congenital talipes equinovarus (CTEV) is a common musculoskeletal anomaly with prevalence ranging from 0.4-7.0 per 1000 live births. The Ponseti method has revolutionized CTEV management, though percutaneous Achilles tenotomy requirements vary across populations. Objective was to evaluate characteristics of infants with CTEV requiring and not requiring tendoachilles tenotomy following Ponseti casting at an Indian tertiary care center.
Methods: A prospective and retrospective cross-sectional study was conducted over 24 months (January 2022-December 2024) involving 44 children with idiopathic CTEV aged <12 months. All patients were treated using standardized Ponseti method with serial casting. Pirani scoring system assessed deformity severity. Statistical analysis compared patients requiring versus not requiring tenotomy using appropriate tests.
Results: The study included 35 males (79.55%) and 9 females (20.45%) with mean age 2.70±2.47 months. Bilateral involvement occurred in 50% of cases. Mean Pirani score improved significantly from 5.55±0.70 to 0.28±0.61 (p<0.001). Ten children (22.73%) required percutaneous Achilles tenotomy while 34 (77.27%) achieved correction through casting alone. Patients requiring tenotomy had significantly higher mean age at presentation (3.5±3.27 vs 2.47±2.19 months, p=0.001), higher initial Pirani scores (5.80±0.63 vs 5.47±0.71, p<0.001), and required more casts (4.5±1.65 vs 3.85±1.33, p<0.001).
Conclusions: The Ponseti method achieved 100% initial correction with relatively low tenotomy requirements (22.73%). Older age at presentation, higher initial Pirani scores, and increased casting requirements significantly predict tenotomy need. Early treatment initiation optimizes outcomes in CTEV management.
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References
Siapkara A, Duncan R. Congenital talipes equinovarus. J Bone Joint Surg Br. 2007;89-B(8):995-1000. DOI: https://doi.org/10.1302/0301-620X.89B8.19008
Douglas WR. Congenital Talipes Equinovarus: Requires Investigative Curiosity to Understand the Definition for Detection, Prevalence, Etiology, Treatment, and Outcomes. Clin Surg. 2020;5:1-10.
Pavone V, Chisari E, Vescio A, Lucenti L, Sessa G, Testa G. The etiology of idiopathic congenital talipes equinovarus: a systematic review. J Orthop Surg Res. 2018;13(1):206. DOI: https://doi.org/10.1186/s13018-018-0913-z
Horton WA. In: Emery Rimoin's Princ. Pract. Med. Genet. Rimoin D, Pyeritz R, Korf B, editors. Elsevier; Sixth. Common skeletal deformities. 2013;1-10.
Miedzybrodzka Z. Congenital talipes equinovarus (clubfoot): a disorder of the foot but not the hand. J Anat. 2003;202:37-42. DOI: https://doi.org/10.1046/j.1469-7580.2003.00147.x
Hackshaw A, Rodeck C, Boniface S. Maternal smoking in pregnancy and birth defects: a systematic review based on 173 687 malformed cases and 11.7 million controls. Hum Reprod Update. 2011;17(5):589-604. DOI: https://doi.org/10.1093/humupd/dmr022
Ippolito E, Gorgolini G. Clubfoot pathology in fetus and pathogenesis. A new pathogenetic theory based on pathology, imaging findings and biomechanics-a narrative review. Ann Transl Med. 2021;9(13):1095. DOI: https://doi.org/10.21037/atm-20-7236
Ponseti IV, Campos J. The classic: observations on pathogenesis and treatment of congenital clubfoot. Clin Orthop Relat Res. 2009;467(5):1124-32. DOI: https://doi.org/10.1007/s11999-009-0721-1
Wallander HM. Congenital clubfoot. Acta Orthop. 2010;81(339):1-25. DOI: https://doi.org/10.3109/17453671003619045
Adegbehingbe OO, Oginni LM, Ogundele OJ, Ariyibi AL, Abiola PO, Ojo OD. Ponseti clubfoot management: changing surgical trends in Nigeria. Iowa Orthop J. 2010;30:7-14.
Ponseti IV, Smoley EN. Congenital club foot: the results of treatment. J Bone Joint Surg Am. 1963;45-A:261-344. DOI: https://doi.org/10.2106/00004623-196345020-00004
Ippolito E, Farsetti P, Caterini R, Tudisco C. Long-term comparative results in patients with congenital clubfoot treated with two different protocols. J Bone Joint Surg Am. 2003;85(7):1286-94. DOI: https://doi.org/10.2106/00004623-200307000-00015
Porecha MM, Parmar DS, Chavda HR. Mid-term results of Ponseti method for the treatment of congenital idiopathic clubfoot--(a study of 67 clubfeet with mean five year follow-up). J Orthop Surg Res. 2011;6:3. DOI: https://doi.org/10.1186/1749-799X-6-3
Jowett CR, Morcuende JA, Ramachandran M. Management of congenital talipes equinovarus using the Ponseti method: a systematic review. J Bone Joint Surg Br. 2011;93(9):1160-4. DOI: https://doi.org/10.1302/0301-620X.93B9.26947
Ponseti IV. Common errors in the treatment of congenital club foot. Int Orthop. 1997;21(2):137-41. DOI: https://doi.org/10.1007/s002640050137
Ponseti IV, Zhivkov M, Davis N, Sinclair M, Dobbs MB, Morcuende JA. Treatment of the complex idiopathic club foot. Clin Orthop Relat Res. 2006;451:171-6. DOI: https://doi.org/10.1097/01.blo.0000224062.39990.48
Dyer PJ, Davis N. The role of the Pirani scoring system in the management of club foot by the Ponseti method. J Bone Joint Surg Br. 2006;88(8):1082-4. DOI: https://doi.org/10.1302/0301-620X.88B8.17482
Mejabi JO, Esan O, Adegbehingbe OO, Ayodele EO, Joseph EA, Hakeem B, et al. The Pirani Scoring System is Effective in Assessing Severity and Monitoring Treatment of Clubfeet in Children. Br J Med Med Res. 2016;17(4):1-9. DOI: https://doi.org/10.9734/BJMMR/2016/27439
Goriainov V, Judd J, Uglow M. Does the Pirani score predict relapse in club foot? J Child Orthop. 2010;4(5):439-44. DOI: https://doi.org/10.1007/s11832-010-0287-1
Morcuende JA, Abbasi D, Dolan LA, Ponseti IV. Results of an accelerated Ponseti protocol for club foot. J Pediatr Orthop. 2005;25(5):623-6. DOI: https://doi.org/10.1097/01.bpo.0000162015.44865.5e
Herzenberg JE, Radler C, Bor N. Ponseti versus traditional methods of casting for idiopathic club foot. J Pediatr Orthop. 2002;22(4):517-21. DOI: https://doi.org/10.1097/01241398-200207000-00019
Lebel E, Karasik M, Bernstein-Weyel M, Mishukov Y, Peyser A. Achilles tenotomy as an office procedure: safety and efficacy as part of the Ponseti serial casting protocol for club foot. J Pediatr Orthop. 2012;32(4):412-5. DOI: https://doi.org/10.1097/BPO.0b013e31825611a6
Dobbs MB, Gordon JE, Walton T, Schoenecker PL. Bleeding complications following percutaneous tendoachilles tenotomy in the treatment of club foot deformity. J Pediatr Orthop. 2004;24(4):353-7. DOI: https://doi.org/10.1097/01241398-200407000-00002
Zhang W, Richards BS, Faulks ST, Karol LA, Rathjen KA, Browne RH. Initial severity rating of idiopathic club feet is an outcome predictor at age two years. J Pediatr Orthop B. 2012;21(1):16-9. DOI: https://doi.org/10.1097/BPB.0b013e32834c31a2
Dobbs MB, Rudzki JR, Purcell DB, Walton T, Porter KR, Gurnett CA. Factors predictive of outcome after use of the Ponseti method for the treatment of idiopathic club feet. J Bone Joint Surg Am. 2004;86-A:22-7. DOI: https://doi.org/10.2106/00004623-200401000-00005
World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191-4. DOI: https://doi.org/10.1001/jama.2013.281053
Canavese F, Dimeglio A. Clinical examination and classification systems of congenital clubfoot: a narrative review. Ann Transl Med. 2021;9(13):1097. DOI: https://doi.org/10.21037/atm-20-7524
Morcuende JA, Dolan LA, Dietz FR, Ponseti IV. Radical reduction in the rate of extensive corrective surgery for club foot using the Ponseti method. Pediatrics. 2004;113(2):376-80. DOI: https://doi.org/10.1542/peds.113.2.376
Shaheen S, Jaiballa H, Pirani S. Interobserver reliability in Pirani club foot severity scoring between a paediatric orthopaedic surgeon and a physiotherapy assistant. J Pediatr Orthop B. 2012;21(4):366-68. DOI: https://doi.org/10.1097/BPB.0b013e3283514183
Radler C, Manner HM, Suda R, Burghardt R, Herzenberg JE, Ganger R, et al. Radiographic evaluation of idiopathic club feet undergoing Ponseti treatment. J Bone Joint Surg Am. 2007;89(6):1177-83. DOI: https://doi.org/10.2106/JBJS.F.00438
Zionts LE, Dietz FR. Bracing following correction of idiopathic club foot using the Ponseti method. J Am Acad Orthop Surg. 2010;18(8):486-93. DOI: https://doi.org/10.5435/00124635-201008000-00005
Saif Ullah M, Md Noor-Ul Ferdous K, Shahjahan M, Abu Sayed S. Management of Congenital Talipes Equino Varus (CTEV) by Ponseti Casting Technique in Neonates: Our Experience. J Neonatal Surg. 2013;2(2):17. DOI: https://doi.org/10.47338/jns.v2.29
Iltar S, Uysal M, Alemdaroğlu KB, Aydoğan NH, Kara T, Atlihan D. Treatment of club foot with the Ponseti method: should we begin casting in the newborn period or later? J Foot Ankle Surg. 2010;49(5):426-31. DOI: https://doi.org/10.1053/j.jfas.2010.06.010
Alves C, Escalda C, Fernandes P, Tavares D, Neves MC. Ponseti method: does age at the beginning of treatment make a difference? Clin Orthop Relat Res. 2009;467(5):1271-7. DOI: https://doi.org/10.1007/s11999-008-0698-1
Mukkaram M, Awais D, Razvi A. Management of congenital talipes equinovarus by Ponseti technique and percutaneous needle tenotomy. Int J Res Orthop. 2025;11:93-8. DOI: https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20243892
Agarwal RA, Suresh MS, Agarwal R. Treatment of congenital clubfoot with Ponseti method. Indian J Orthop. 2005;39:244-7.
Bor N, Coplan JA, Herzenberg JE. Ponseti treatment for idiopathic clubfoot: minimum 5-year follow up. Clin Orthop Relat Res. 2009;467(5):1263-70. DOI: https://doi.org/10.1007/s11999-008-0683-8
Bor N, Herzenberg JE, Frick SL. Ponseti management of clubfoot in older infants. Clin Orthop Relat Res. 2006;444:224-8. DOI: https://doi.org/10.1097/01.blo.0000201147.12292.6b
Zhao D, Li H, Zhao L, Liu J, Wu Z, Jin F. Results of clubfoot management using the Ponseti method: do the details matter? A systematic review. Clin Orthop Relat Res. 2014;472(4):1329-36. DOI: https://doi.org/10.1007/s11999-014-3463-7
Gupta A, Singh S, Patel P, Patel J, Varshney MK. Evaluation of the utility of the Ponseti method of correction of clubfoot deformity in a developing nation. Int Orthop. 2008;32(1):75-9. DOI: https://doi.org/10.1007/s00264-006-0284-7
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