Butt MN1, Khan I1, Roshan S1
1Muzaffarabad Physical Rehabilitation Centre, Physical Therapy, Muzaffarabad, Pakistan
Background: Congenital tallipes Equinovarus (Clubfoot) is a three dimensional birth defect that has prevalence of 1 per 1000 live births [1]. Ponseti technique is well known method to treat clubfoot deformity [2-4]. A lot of researches have been done on its effectiveness in treating clubfoot deformity [5-14]. Our focus was to compare the outcomes of ponseti for three different types of clubfoot and to find out the factors that can affect the outcomes.
Purpose:
A. To evaluate and compare the outcomes of ponseti technique for the management of different types of clubfoot (idiopathic (untreated)[15], recurrent[16] and syndromic[17]).
B. To evaluate the factors that can affect the outcomes of treatment.
C. To evaluate the factors that leads to the use of foot orthosis in walking age.
Methods: It was retrospective analysis of 151 clubfoot Children (idiopathic untreated, syndromic and recurrent) with at least one year follow up conducted in Muzaffarabad Physical Rehabilitation Centre, Azad Jammu & Kashmir, Pakistan. Duration was 3 months (June 2018 to August 2018). Data was collected using self-structured questionnaire from the file records of the centre from year 2013 to 2017. Convenient sampling was done. Data was analysed using SPSS-21.
Results: 151 children with 235 clubfeet were treated with ponseti technique and 2 year follow up was done. 96 (63%) were idiopathic untreated, 40 (26.5%) were recurrent and 15 (9.5%) were syndromic clubfoot. 115(76%) children were male and 36(24%) were female. Out of 151 Children only 39 (25%) children had tenotomise. Less number of tenotomise was due to unavailability, affordability and busy schedule of only available orthopaedic surgeon. The main difference that was seen in three types of clubfoot was average number of cast which was 9, 5 and 4 casts per foot for syndromic, idiopathic and recurrent. There was no significant difference in baseline pirani score of three groups (p-value>0.05). After one year of follow up there was significant difference in pirani score of idiopathic and syndromic clubfoot (p-value 0.05) and between recurrent clubfoot and syndromic clubfoot (p-value 0.01). The aetiology of syndromic clubfoot affects the outcomes of ponseti technique as co-morbidities leads to relapse. Both in Recurrent and idiopathic (untreated) Clubfoot, poor brace compliance and lack of tenotomy has been associated with relapse. Baby cry (18.5%) and parents negligence (17.5%) has been associated with poor brace compliance. Poor brace compliance and lack of tenotomy leads to relapse and thereby use of ankle foot orthosis become obligatory in walking age.
Conclusion(s): Aetiology of syndromic clubfoot affects the outcomes of ponseti techniques and leads to relapse because of co-morbidities. In idiopathic (untreated) and Recurrent Clubfoot ponseti technique does not have significant difference in outcome. Poor brace compliance and lack of tenotomy leads to relapse of clubfoot and orthotic use.
Implications:
1. Education of parents about the clubfoot deformity, its management and consequences of not following standard protocols.
2. Improvement in referral link with orthopaedic surgeon.
3. In case of poor brace compliance close follow ups must be done.
Keywords: Foot abduction Brace, ponseti, tenotomy.
Funding acknowledgements: Special thanks to International Committee of Red Cross & our receptionist Shabbir Hussain for his cooperation in file work.
Purpose:
A. To evaluate and compare the outcomes of ponseti technique for the management of different types of clubfoot (idiopathic (untreated)[15], recurrent[16] and syndromic[17]).
B. To evaluate the factors that can affect the outcomes of treatment.
C. To evaluate the factors that leads to the use of foot orthosis in walking age.
Methods: It was retrospective analysis of 151 clubfoot Children (idiopathic untreated, syndromic and recurrent) with at least one year follow up conducted in Muzaffarabad Physical Rehabilitation Centre, Azad Jammu & Kashmir, Pakistan. Duration was 3 months (June 2018 to August 2018). Data was collected using self-structured questionnaire from the file records of the centre from year 2013 to 2017. Convenient sampling was done. Data was analysed using SPSS-21.
Results: 151 children with 235 clubfeet were treated with ponseti technique and 2 year follow up was done. 96 (63%) were idiopathic untreated, 40 (26.5%) were recurrent and 15 (9.5%) were syndromic clubfoot. 115(76%) children were male and 36(24%) were female. Out of 151 Children only 39 (25%) children had tenotomise. Less number of tenotomise was due to unavailability, affordability and busy schedule of only available orthopaedic surgeon. The main difference that was seen in three types of clubfoot was average number of cast which was 9, 5 and 4 casts per foot for syndromic, idiopathic and recurrent. There was no significant difference in baseline pirani score of three groups (p-value>0.05). After one year of follow up there was significant difference in pirani score of idiopathic and syndromic clubfoot (p-value 0.05) and between recurrent clubfoot and syndromic clubfoot (p-value 0.01). The aetiology of syndromic clubfoot affects the outcomes of ponseti technique as co-morbidities leads to relapse. Both in Recurrent and idiopathic (untreated) Clubfoot, poor brace compliance and lack of tenotomy has been associated with relapse. Baby cry (18.5%) and parents negligence (17.5%) has been associated with poor brace compliance. Poor brace compliance and lack of tenotomy leads to relapse and thereby use of ankle foot orthosis become obligatory in walking age.
Conclusion(s): Aetiology of syndromic clubfoot affects the outcomes of ponseti techniques and leads to relapse because of co-morbidities. In idiopathic (untreated) and Recurrent Clubfoot ponseti technique does not have significant difference in outcome. Poor brace compliance and lack of tenotomy leads to relapse of clubfoot and orthotic use.
Implications:
1. Education of parents about the clubfoot deformity, its management and consequences of not following standard protocols.
2. Improvement in referral link with orthopaedic surgeon.
3. In case of poor brace compliance close follow ups must be done.
Keywords: Foot abduction Brace, ponseti, tenotomy.
Funding acknowledgements: Special thanks to International Committee of Red Cross & our receptionist Shabbir Hussain for his cooperation in file work.
Topic: Musculoskeletal: lower limb
Ethics approval required: Yes
Institution: Muzaffarabad Physical Rehabilitation Centre
Ethics committee: Muzaffarabad Physical Rehabilitation Centre Ethical committee
Ethics number: 973/Admin/2018
All authors, affiliations and abstracts have been published as submitted.
