ROLES OF PHYSIOTHERAPISTS IN PROVIDING PONSETI TREATMENT FOR CLUBFOOT CHILDREN AND HOW COULD INVOLVE IN GRADING UP TREATMENT COVERAGE WORLDWIDE

¹ICRC, Physical Rehabilitation Program, Najaf, Iraq

Background: Clubfoot deformity is a common congenital problem caused by abnormal development of bones, ligaments, and muscles of the baby in the uterus. By medical point of view, it’s characterized by calf muscle atrophy, hind foot varus, fore foot Cavus and Adductus and Ankle Equinus .It can cause lifetime disability pain and difficulty in walking if remained untreated. The socioeconomic consequences may affect the education and acceptance in the society. Clubfoot is widely managed through Ponseti technique by variety of healthcare specialists.

Purpose: Purposes are to review role of physiotherapist at Iraqi Clubfoot clinics and to strengthen the ability to be an effective member of Clubfoot treatment.

Methods: This was a retrospective audit conducted from 2018 to 2022 on153 idiopathic clubfoot children enrolled in Najaf Clubfoot clinic. Ponseti technique including casting by Physiotherapist under OS was used in these Children followed by small surgical procedure named tenotomy in most of cases to achieve full range of dorsiflexion, later with Splint and exercises for maintenance foot movements .Pirani scoring was used for initial and follow up assessment.

Results: About 153 of idiopathic clubfoot children with 232 feet and Follow up done for 50.Their ages from 3 days to 5 years. More than half 54.2% were in the first three months of age. There were 99(64.7%) boys and 54 girls (35.3%).15.6% children with bilateral 79 and 48.4% with unilateral 74. The severity was assessed using Pirani scoring reported that most of the cases were severe type (average of Pirani score 5.2) in 70.6% of 164 feet. The follow up of 50 patients (31 Bilateral and 19 unilateral) presented in the first 4 weeks of age with severe type (average Pirani score of pre-treatments between 5.32-5.35 and post-treatment between 0.12-0.53) treated by Ponseti method. Good results were reported in 91% of feet treated within the first week, When treatment was delayed to second, third or fourth week, the rates became 80%,70%,54% respectively.

Conclusions: Ponseti technique is clinically significant and effective in managing Clubfoot across any age from 0-24 months .Its effective for male and female with different Pirani scoring outcomes and treatment with physiotherapists under OS supervision was successful. Starting treatment early will avoid many deformities. Family compliance with use of stretching exercises and splinting is a major factor ruling the rate of successful results after treatment.

Implications: This study gives physiotherapist the confidence ability to be an effective member of MDT as he is the one responsible of casting under the doctor supervision, filling Pirani score charts and encourage parents in mastering stretching exercises and using splints throughout the treatment period to avoid relapses. Physiotherapist have a very important role in the treatment: critical thinking, reasoning skills, evaluation, the time should spend with patients' families, mean that they are well placed to lead, provide, and improve many aspects of clubfoot treatment using national clubfoot program coordination.

Funding acknowledgements: ICRC/Personal funding

Keywords:
Clubfoot
Pirani scoring
Ponseti technique

Topics:
Paediatrics
Paediatrics

Did this work require ethics approval? Yes

Institution: ICRC/Clubfoot clinic

Committee: ICRC/PRP Manager and responsible of Clubfoot clinic

Ethics number: 9647835417814