CLUB FOOT AFTER TREATMENT

PATTERN AND CAUSES OF RELAPSES WITH PONSETI TECHNIQUE

Abstract

Background: Ponseti technique for club foot treatment has become more
popular during the last decade. But the most common problem following correction by
Ponseti technique is the relapse of deformity. Setting: Dow University Hospital as well as
other hospitals were included in the study. Period: April 2013 to April 2016. Methods: 335
children with idiopathic club foot presented in OPD with relapse, treated with Ponseti technique.
Pirani scoring was used to assess the severity of relapse. Children with both unilateral and
bilateral involvement, aged up to 5 years were included. 335 children with idiopathic club feet
who underwent treatment with Ponseti technique, presented with relapse of deformity were
enrolled in the study. Results: There were 207(59.7%) boys and 128(37%) girls. Mean age at
presentation for casting (previous treatment age) was 5.98 months (SD ±6.07), and 153(44.2%)
had Right sided involvement, 112 (32.4%) had left sided involvement and 69(19.9%) had
bilateral involvement. Mean age at which relapse occurred was 24.7 months (SD ±7.35). The
mean Pirani score was 4.78 (SD ±4.30). Percutaneous heel cord tenotomy was done in 286
(82.7%) children. Number of cast to maintain initial correction was 7.58 (SD ±1.19).Out of 335
patients 246(71.1) used brace and out of them 123 (50%) used brace up to one year, 70 (25.5%)
used for1-2 years, 30 (15.5%) used for 2-3 years and 23 (9%) used for 3-4 years. Conclusion:
Ponseti method is safe and effective method of treatment for club foot. Despite the proper use of
Ponseti method, relapses and recurrences still occurs due to certain factors. The best treatment
for recurrent club foot is prevention in the form of consistent primary treatment, constant use of
braces and regular follow up