Management of clubfoot by Ponseti Technique

We report our experience of using the Ponseti method for the treatment of congenital idiopathic clubfoot. From August 2007 to July 2010 we treated 107 feet in 79 patients by this method with the mean follow-up time of 15 months. The standard protocol described by Ponseti was used ex except that when necessary percutaneous tenotomy of tend-achillis were performed under general anaesthesia in the operation theater and change of plastar fortnightly. The Pirani score was used for assessment. The objectives of the study were to access the results in terms of the nuber of casts applied, the need for tenotomy of tend-achillis and recurrence of deformity. Tenotomy was required in 87 of the 107 feet. Ten feet failed to respond to the initial treatment regimen and required extensive soft-tissue release. Of the 97 feet which responded to initial casting, 35 (32.71%) had a recurrence, 19 of which were successfully treated by repeat casting and/or tenotomy and casting. The remaining 16 required extensive soft-tissue release and external fixator application. Poor compliane with the foot-abduction orthoses (Dennis Browne Splint) was thought to be the main cause of failure in these patients.