Comparison of Functional and Radiological Outcome of Children Aged 5-10 years with Clubfoot Treated Previously Either by Ponseti Method or Surgical Release – A Minimum 4-year Follow-up (Case Series of 28 Children as Cross-sectional Study)
Journal Title: Journal of Karnataka Orthopaedic Association - Year 2019, Vol 0, Issue 0
Abstract
Aim: This study aims to compare the functional outcome in children aged 5-10 years with clubfoot previously treated by either Ponseti or posteromedial soft tissue release (PMSTR) with minimum follow-up of 4 years following final casting. Objectives: The objectives of this study were as follows: (1) To compare the functional outcome between the two methods, (2) to determine whether correlation exists between functional outcome and radiographic measurements of both groups, and (3) to compare results with the literature. Materials and Methods: The study was conducted in Tejasvini Hospital and SSIOT. Medical records of clubfoot patients operated between January 2008 and December 2011 were reviewed. Communication was sent to them and scheduling of appointments for the assessment was made. 28 patients with 45 feet who met the inclusion criteria were assessed. Objective evaluation was made using standard standing AP/lateral foot radiographs and subjective evaluation was made using LaavegPonseti 100-point scoring system includes subjective and objective questionnaire and tabulated. The observation was subjected to statistical analysis. Results: (1) Of 45 foots, Laaveg-Ponseti score showed excellent in 18 feet, good in 16 feet, moderate in 4 feet, and poor in 7 feet, (2) patient managed with Ponseti has higher excellent/good outcome as compared to PMSTR (90.5% and 62.5%, respectively) but not to the point of statistically significant with P = 0.152, (3) lower talo-1st metatarsal lateral (TMT-LT) (P = 0.004), lower TMT anteroposterior (AP) (P = 0.001), lower calcaneum-5th metatarsal AP (P = 0.005), and high talocalcaneal angle in lateral (P = 0.015) angles are correlated with excellent/good functional outcome with statistically significant P < 0.05, and (4) there were no other significant correlations between the functional and radiographic outcomes. Conclusion: (1) Our study supports the routine use of radiography during follow-up and using wide range of parameters instead of anyone radiologic parameter, (2) serial manipulation and casting are the preferred initial treatment of choice for idiopathic clubfeet, and soft tissue release is reserved for clubfeet that cannot be completely corrected as it will lead to stiff painful foot and low functional outcome. A strict brace compliance remains the major challenge of the Ponseti method.
Authors and Affiliations
M Ajith Kumar, Jay Rajesh Shah
Keywords
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