Comparison of Ponseti and Kite's method of treatment for congenital Talipes Equino using the Pirani scoring system

Abstract

Objective: The study was carried out to compare the effectiveness of the Ponseti manipulation versus the
Kite's manipulation in the treatment of idiopathic Congenital Talipes Equino Varus (CTEV) as evaluated by
the Pirani score.

Design: An intervention study, prospective non randomized trial.

Setting:Hospital based study at three central hospitals namely Harare Central Hospital (HCH), Parirenyatwa Group of Hospitals (PGH) and Chitungwiza Central Hospitals (CCH) in Zimbabwe. Subjects: 38 feet in 25 patients, 13 bilateral and 12 unilateral CTEV deformities in children less than one year of age and without prior manipulation or surgical treatment were purposively allocated to either Ponseti (20 feet) or Kite's method (18 feet) at three central hospitals. There were no dropouts.

Intervention: Participants in two hospitals were managed using the Ponseti method and one hospital managed participants using the kite's method. Baseline Pirani scores were measured before the first treatment was done. Thereafter they were followed up weekly and analysis was done for three and six week outcomes using the Pirani score. Correction was measured by the difference between the baseline hindfoot, midfoot and total scores and the Pirani scores at three weeks and six weeks. Within group analysis of the data was done using a single student t - test and between groups analysis was done using the independent student t - test.

Results: Both methods were effective in correcting CTEV deformity. Feet managed by the Ponseti method showed faster rates of decrease in Pirani score (improvement) as compared to feet treated by Kite's method. The between group analysis (Kite Ponseti) at three weeks was -1,4056 (p = 0.0000) [CI = -1.900 to -0.9103] showing a significantly difference between the methods at three weeks. The between group analysis (Kite Ponseti) at six weeks was -2.2302 (p = 0.0000) [CI = -2.9789 to -1.4815] showing a significantly difference between the methods at six weeks.

Conclusion: Ponseti management causes faster improvement in CTEV deformity using the Pirani scores than Kite management at three weeks and six weeks. It would therefore be more efficacious to use the Ponseti method of manipulation in the conservative management of CTEV. Issues of cost effectiveness will need to be researched further.