Ponseti Technique for CTEV: Our Experience at TMCH

Abstract

Background and Objective: Congenital talipes equinovarus (CTEV) also known as clubfoot is one of the common congenital orthopedic foot deformities in children. It is a complex deformity that is hard to correct, and the management is arguable and continues to be one of the significant challenges in pediatric orthopedics. It is believed that the initial treatment should be nonsurgical, which is started soon after birth within the first 2 weeks of life. We aimed to assess the efficacy of Ponseti’s technique for the treatment of CTEV in our institute for 6 years. Materials and Methods: One hundred eighty patients between 2 weeks and 12 years of age who had attended the CTEV clinic of the Department of Orthopaedics of our medical college in the last 6 years, until December 2020, were taken for the study to correct idiopathic CTEV using the Ponseti technique. Children included in the study were assessed every week before cast placement for the severity of the deformity using the Pirani scoring system. Once a week, manipulation and serial casting of the CTEV foot were started by the technique described by Ponseti. Patients were followed up at weekly intervals until forefoot and midfoot deformities were corrected. Percutaneous Achilles tenotomy was done to prevent rocker-bottom deformity and for correcting Equinus deformity after correction of other deformities. All patients were maintained on foot abduction brace after correction until 4 years of age or more. Results: At 6-month follow-up, Ponseti’s technique gave us 84.8% excellent results, 13.1% good results, and 2.1% poor results. A total of 86.6% required percutaneous tenotomy, whereas 13.4% did not require tenotomy. Conclusion: The Ponseti technique is still a safe, economical, and convenient treatment modality for CTEV, which gives successful results, and thus radically decreases the need for extensive corrective surgery even in older children.