Comparison of 1 Week Accelerated Ponseti and Standard Ponseti Technique for Management of Idiopathic Congenital Talipes Equinovarus Deformity in Infants: A Randomized Controlled Trial.

Abstract

Background: The implementation of the standard Ponseti technique (SPT) in management of idiopathic clubfoot can be challenging due to the need for frequent travelling and long duration to achieve correction. The one week accelerated Ponseti technique (OWAPT) reduces the duration of correction to seven days and has been reported to be effective and safe. However, children still need to travel for change of cast.

Methods: A randomized controlled trial was conducted to compare the SPT and OWAPT for their effectiveness, safety and treatment expenditure. Children under one year of age with untreated idiopathic CTEV were included. Those undergoing correction with OWAPT were hospitalized till tendo-achillis tenotomy. The relevant data was collected and analyzed using appropriate statistical methods.

Results: Forty six children (68 feet) were enrolled with 22 (33 feet) in OWAPT group and 24 (35 feet) in SPT group. The mean age at treatment in OWAPT and SPT group was 1.55 months and 2.91 months, while their mean Pirani score was 4.59 and 4.70 respectively. The Pirani score improved significantly within both groups without any significant difference between the two groups. The total number of casts required to achieve correction were also comparable (p = 0.779). The OWAPT was observed to be more economical (p < 0.001) but had more minor complications.

Conclusion: The OWAPT is equally effective, achieves faster correction and is more cost-effective than SPT. Its implementation by hospitalizing the children avoids travelling issues and achieves 100% compliance during correction phase. Hospitalization also ensures better plaster care and monitoring for complications.