Efficacy of the Ponseti method in the treatment of neglected idiopathic talipes equinovarus at a tertiary hospital in Nigeria

Abstract

Neglected clubfoot is common in our environment, for multifactorial reasons. It could cause pain and psychological distress to the patient and parents. We assessed the efficacy of the Ponseti method in the treatment of neglected clubfoot in a Nigerian Hospital. This was a 15-month prospective and interventional study. Patients at least one-year-old with untreated idiopathic talipes equino varus (ITEV) or inadequately nonoperatively treated ITEV were the study population. The number of castings required for correction, tenotomy rate, dorsiflexion angle before and after tenotomy, and abduction angle after treatment were obtained. The chi-square test of independence was used to test the relationship between categorical variables. Logistic regression was used to assess if the Pirani score at the presentation predicted a successful correction at the end of the study. The level of significance was set at P < 0.05. Forty-two children with 69 club feet were treated in this study. The mean age of presentation was 27.45 months (standard deviation [SD] = 19.22). The mean number of casting sessions required to achieve correction was 6.35 (SD = 1.95). The mean Pirani score at presentation was 4.27 (SD = 1.33) which reduced to 0.30 (SD = 0.35) after correction. The Pirani score at presentation had a positive correlation with the number of casts required for correction (r = 0.505, P < 0.001) but did not predict a successful correction after treatment. The success rate was 85.5%. The Ponseti method of treatment showed a high success rate in the treatment of neglected ITEV.