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Rather A.1, Drabu N.2, Sami-Ullah Kant M.3, Parvez Z.4
1Physiotherapist, International Committee for the Red Cross (ICRC), Physical Rehabilitation Program, Srinagar, India, 2Orthopedician, JLNM Hospital, Orthopedics, Srinagar, India, 3Physiotherapist, JLNM Hospital, Physiotherapy, Srinagar, India, 4State Coordinator, Cure International India, MSW, Srinagar, India
Background: Around the world, 150,000 - 200,000 babies are born with clubfoot each year. In India, a baby is born with clubfoot every 10 minutes, with over 50,000 children born with clubfoot every year (one out of every 500). Without treatment, clubfoot can cause a lifelong disability. The minimally-invasive Ponseti method has been swiftly gaining popularity in low- and middle-income countries, where most of the world´s club foot children are born. Untreated children with clubfoot find it difficult to access education, employment and experience exclusion from society. As part of its Physical Rehabilitation Program, the International Committee of the Red Cross helps to treat clubfoot in many countries.
Purpose: To present treatment response in a child with neglected idiopathic bilateral clubfoot with the Ponseti method.
Methods: ZA has neglected idiopathic bilateral clubfoot. He is an eleven-year-old healthy school going boy. ZA was referred to the clubfoot clinic from one of the remote districts of Kashmir Valley. The Clubfoot clinic is run by the Ministry of Health, Jammu & Kashmir, supported by Cure International and the International Committee of the Red Cross.
After detailed assessment and proper counselling, Ponseti serial casting was started to ZA. Eight serial casts were applied to correct, the cavus, adductus and varus deformities and every week the Pirani scoring was recorded. A percutaneous heel-cord tenotomy was performed to correct the equinus, followed by a three-week casting. This correction was maintained with a foot-abduction brace (FAB), initially 23 hours a day for three months, and then followed by night splinting, which will continue for approximately three years. The parents were taught how to stretch the foot upon removal of the splints. ZA and his family provided written consent to present his case.
Results: The deformities of ZA were corrected after nine serial casts. The midfoot and forefoot were corrected to Pirani 0 in both feet after eight casts. The equinus was corrected to neutral by a percutaneous tenotomy. His hindfoot Pirani score was also recorded as 0 after the removal of a three-week casting after his tenotomy. There were no major complications during the procedures
Conclusion(s): The treatment of neglected clubfoot in children nearing skeletal maturity was usually performed by means of Ilizarov distraction osteogenesis, arthrodesis, or osteotomy associated with soft-tissue release. The treatment of idiopathic clubfoot with the Ponseti method was initially recommended for infants before walking age, with excellent results. More recently, good results are seen with the Ponseti method in children over the age of seven years with neglected clubfoot. Thus, Ponseti can significantly reduce the need for surgical intervention in older children and minimizes the need for extensive corrective surgery.
Implications: The effects of Ponseti can be further enhanced by Physiotherapy, like stretching tight structures and strengthening antagonist muscles. Physiotherapists should be equipped with adequate clinical knowledge of clubfoot management using the Ponseti method. Physiotherapists should also raise awareness and promote the Ponseti method in national and international fora, with an aim to develop national clubfoot initiatives in various countries.
Funding acknowledgements: None
Topic: Musculoskeletal: lower limb
Ethics approval: Ethics approval not required
All authors, affiliations and abstracts have been published as submitted.
