Evaluation of an accelerated Ponseti protocol for the treatment of talipesequinovarus in Nigeria

Abstract

Background: The commonest congenital musculoskeletal deformity worldwide is talipes equino varus (CTEV). Of the various treatment methods available, the most acceptable treatment currently for CTEV worldwide is serial manipulation and casting using the Ponseti technique. The Ponseti technique consists of weekly manipulation and casting for an average of six to eight weeks followed by bracing of the feet till school age. Some studies have shown evidence that more frequent casts may have similar outcomes with weekly casts using the Ponseti method. This study compared the efficacy of management of idiopathic CTEV using an accelerated protocol of twice weekly casts, with the standard weekly Ponseti protocol.

Methods: The study was a randomized case control study with a group of patients undergoing an accelerated casting protocol involving twice weekly casts compared with another group who went through the normal weekly Ponseti protocol.

Results: A total of 45 feet in 28 patients were studied. The study showed a significantly shorter treatment period in the accelerated protocol (39 days) compared with the standard protocol (52 days); with no significant increase in the number of casts needed for treatment.

Conclusions: A twice weekly Ponseti casting protocol enables completion of the casting period earlier than the standard Ponseti method.

Keywords: Talipes equinovarus; Ponseti treatment; Accelerated Ponseti Protocol; Serial Casting