The neglected clubfoot: is Ponseti method effective?

Abstract

Background: Neglected clubfoot is still a common presentation especially in developing countries typified by poor access to health care, leading to these patients with untreated clubfoot to present at walking age. It presents a challenge to management, with opinions divided on the appropriate initial modality of treatment; whether operative or conservative.

Objective: To evaluate the effectiveness of the Ponseti technique in the treatment of neglected clubfoot.

Methodology: Thirteen neglected clubfeet, in 10 patients who presented after walking age were evaluated. Pre-treatment Pirani scores were obtained, and all patients were treated by the method described by Ponseti (manipulation and casting, including Achilles tenotomy as needed). Post treatment Pirani scores were also obtained at the end of treatment.

Results: A painless plantigrade foot was obtained in all (100%) feet without the need for extensive soft tissue release and/ or bony procedures.

Conclusion: Ponseti method is effective in the treatment of neglected clubfoot presenting after walking age.

Keywords: Pirani score, Plantigrade foot, Tenotomy, Soft tissue release