Congenital idiopathic talipes equinovarus: an evaluation in infants treated by the Ponseti method

V. Pavone, G. Testa, L. Costarella, P. Pavone, G. Sessa

Orthopaedic Clinic, and 1Pediatric Clinic; Polyclinic Vittorio Emanuele, Azienda Ospedaliera Universitaria, University of Catania, Catania, Italy. ppavone@unict.it

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• Orthopedics

BACKGROUND: Congenital talipes equinovarus (CTEV) is a common but still not fully understood disorder of the lower limb. It is usually defined as a fixation of the foot in adduction, supination, and varus. Different treatment options exist including the Ponseti method.

AIM: We report here the results obtained in infants with CTEV treated by the Ponseti method.

PATIENTS AND METHODS: Eighty two patients (114 clubfeet) were enrolled at the Orthopaedic Clinic of Catania University during the period of March 2004 to January 2010 and followed prospectively up to February 2011: 56 patients (68.29%) were male, the anomaly was bilateral in 32 (39%) cases, unilateral in 50 (60.9%) in the right side in 28 (56%). The mean age at initiation of treatment was 14 days (range 3-81 days), severity of the club foot deformity by the Pirani Severity score was 5.56 points (range 4.3-6 points). Total numbers of Ponseti casts before tenotomy, details of tenotomy, and compliance with CTEV brace were recorded. Clinical evaluation was performed using the functional Ponseti Scoring System. Mean follow up was 4 years: range 13-83 months.

RESULTS: An average of 6.6 casts was necessary before performing the tenotomy. Tenotomy was performed by a single surgeon (V.P.) in a total of 68 patients (82.93%) always in an operating room under general anaesthesia by a percutaneous approach at a mean age of 106 days (range 45-213 days). Compliance with CTEV brace was satisfactory in 79 patients (96.3%). Functional Ponseti Scores were good/excellent in 79 (96.34%) patients (109 clubfeet; 95.61%). Only 3 patients; 3.7% (5 clubfeet; 4.4%) suffered relapse. Poor compliance with the Denis Browne splint was thought to be the main cause of failure.

CONCLUSIONS: The Ponseti method provides an excellent outcome at follow up in the treatment of congenital idiopathic clubfoot.

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