Role of Ponseti Technique in Late Presenting and Relapsed Idiopathic Congenital Talipes Equinocavo Varus Feets – Our Experience
Abstract
Objectives: Idiopathic Congenital Talipes Equino Varus (CTEV), commonly referred to as Clubfoot, is a complex musculoskeletal deformity affecting infants. The Ponseti technique, a gold standard approach, has emerged as an effective treatment. This study aims to evaluate the clinical outcomes of ponseti technique in children with idiopathic clubfoot who presents late after 03 months of birth and in relapsed infants up to one year of age.
Methods: A prospective study was conducted at the Department of Orthopaedics, involving 41 feet. Infants with idiopathic clubfoot were included. Infants started on ponseti treatment with serial castings followed by percutaneous tendo Achilles tenotomy corrections were monitored by scoring systems, Paired samples ‘T’ was applied for statistical analysis. The statistical difference was considered to be significant when P <0.05 and highly significant when P < 0.001. Correlation between different parameters was analyzed by Spearman correlation coefficient.
Results: we treated 29 cases (41 feet) of idiopathic clubfoot in children more than three months. Age group classification was: group 1 (3 to 5 months), group 2(6 to 9 months) , group 3 (10 to 12 months) and group 4 (> 12 months). In group 1 mean pre Pirani and Dimeglio scores were higher than group 4, reduction of scores after corrective casting were more statistically significant in group 1 than group 2,3,4. This suggests that the Ponseti technique is effective in older age group but the effectiveness decreases as the age increases.
Conclusion : Thus Ponseti technique safe, effective and can be used as preferred initial treatment for congenital idiopathic clubfoot in patients presenting late, irrespective of age and initial severity , avoiding the need for extensive surgery later
Downloads
Metrics
References
Morcuende JA, Dolan LA, Dietz FR, Ponseti IV. Radical reduction in the rate of extensive corrective surgery for clubfoot using the Ponseti method. Pediatrics. 2004 Feb; 113(2):376-80.
Congenital Clubfoot: Fundamentals of Treatment by Ignacio V. Ponseti Publisher: Oxford University Press; 1st edition (January 15, 1996)
Segav E, Keret D lokiec F. Early Experience with the Ponseti Method for the treatment of congenital idiopathic clubfoot. Isr Med Assoc J 2005; 7:307-310.
Goksan S B, Bursali A, Bilgili. Ponseti technique for the correction of idiopathic clubfoot presenting up to 1 year of age. A preliminary study in children with untreated or complex deformities. Arch Orthop Trauma surg 2006; 126: 15-26.
Chaudhry S, Chu A, Labar AS, Sala DA, van Bosse HJ, Lehman WB. Progression of idiopathic clubfoot correction using the Ponseti method. J Pediatr Orthop B. 2011 Apr 27.
Gaston Terrazas-Lafargue, M.D., and Jose A. Morcuende. Effect of Cast Removal Timing in the Correction of Idiopathic Clubfoot by the Ponseti Method; Iowa Orthop J. 2007; 27: 24–27
Shawne Faulks RN, MSN, CNS, B. Stephens Richards MD. Clubfoot Treatment Ponseti and French Functional Methods are Equally Effective. Clin Orthop Relat Res (2009) 467:1278–1282.
Ashish Anand and Debra A Sala. Clubfoot: Etiology and treatment; Indian J Orthop. 2008 Jan-Mar; 42(1): 22–28.
Porter RW. Congenital talipes equinovarus: Resolving and resistant deformities. J Bone Joint Surg Br. 1987;69:822–5.
Feldbrin Z, Gilai AN. Muscle imbalance in the aetiology of idiopathic club foot. An electromyographic study. J Bone Joint Surg Br. 1995 Jul;77(4):596-601.
Turco VJ. Clubfoot. New York: Churchill Livingstone; 1981.
Lehman WB. The clubfoot. New York: JB Lippincott; 1996.
Adams W. Clubfoot: Its causes, pathology and treatment. London: J and A Churchill; 1866.
Adams W, Brockman EP. Congenital clubfoot. Bristol: John Wright and Sons; 1930.
Johnston CE, Hobatho MC. Three-dimensional analysis of clubfoot deformity by computed tomography. J Pediatr Orthop B. 1995;4(1):39-48.
Changulani M, Garg NK, Rajagopal TS, Bass A, Nayagam SN, Sampath J, Bruce CE. Treatment of idiopathic club foot using the Ponseti method. Initial experience. J Bone Joint Surg Br. 2006 Oct; 88(10):1385-7.
Verma A, Mehtani A. Management of idiopathic clubfoot in toddlers by Ponseti's method. J Pediatr Orthop B. 2011 Jun 9.
Ignacio V. Ponseti. Current Concepts Review Treatment of Congenital Club Foot. J. Bone and Joint Surg., 74-A, No. 3. March; 449-452.
Chotel F, Parot R, Seringe R, Berard J, Wicart P. Comparative study: Ponseti method versus French physiotherapy for initial treatment of idiopathic clubfoot deformity. J Pediatr Orthop. 2011 Apr-May;31(3):320-5.
Yagmurlu MF, Ermis MN, Akdeniz HE, Kesin E, Karakas ES. Ponseti management of clubfoot after walking age. Pediatr Int. 2011 Feb;53(1):85-9.
Flynn JM, Donohoe M, Mackenzie WG. An independent assessment of two clubfoot-classification systems. J Pediatr Orthop. 1998 May-Jun;18(3):323-7.
Rijal R, Shrestha BP, Singh GK, Singh M, Nepal P, Khanal GP, Rai P. Comparison of Ponseti and Kite's method of treatment for idiopathic clubfoot. Indian J Orthop. 2010 ;44(2):202-7.
Parada SA, Baird GO, Auffant RA, Tompkins BJ, Caskey PM.. Safety of percutaneous tendoachilles tenotomy performed under general anesthesia on infants with idiopathic clubfoot. J Pediatr Orthop. 2009 ;29(8):916-9.
Park SS, Kim SW, Jung BS, Lee HS, Kim JS. Selective soft-tissue release for recurrent or residual deformity after conservative treatment of idiopathic clubfoot. J Bone Joint Surg Br. 2009;91(11):1526-30.
Chomiak J, Frydrychová M, Ostádal M, Matejícek M.. The Ponseti method of treatment of congenital clubfoot--first experiences. Acta Chir Orthop Traumatol Cech. 2009 ;76(3):194-201.
Wijayasinghe SR, Abeysekera WY, Dharmaratne TS. Descriptive epidemiology of congenital clubfoot deformity in Sri Lanka. J Coll Physicians Surg Pak. 2018;28:166-8.
Bozkurt C, Sipahioglu S. Effects of younger siblings on the brace compliance and recurrence in children with clubfoot during Ponseti treatment. Acta Orthop Traumatol Turc. 2021;55:102-6.
Ishizuka T, Hung YY, Weintraub MR, Kaiser SP, Williams ML. Ponseti idiopathic and nonidiopathic clubfoot correction with secondary surgeries. J Foot Ankle Surg. 2021;60:742-6.
Janatová K, Nováková T, Lopot F. The incidence of clubfoot in the Czech republic: A nationwide epidemiological study from 2000 to 2014. Children (Basel). 2023;10:714.
garwal A, Rastogi A, Rastogi P. Relapses in clubfoot treated with Ponseti technique and standard bracing protocol-a systematic analysis. J Clin Orthop Trauma. 2021;18:199-204.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Naveenkumar Patil
This work is licensed under a Creative Commons Attribution 4.0 International License.
You are free to:
- Share — copy and redistribute the material in any medium or format
- Adapt — remix, transform, and build upon the material for any purpose, even commercially.
Terms:
- Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
- No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.
