Accelerated versus conventional Ponseti protocol for the treatment of idiopathic talipes equinovarus deformity: A short term follow up in Iraq

  • Jagar Omar Doski Department of Surgery, Medical College, University of Duhok, Duhok, Iraq.
  • Berivan Ibrahim Jamal Department of Orthopaedics, Hawler Teaching Hospital, Erbil, Iraq.
Keywords: Clubfoot, Congenital talipes equinovarus, Ponseti, Accelerated, Cast

Abstract

Background and objective: The accelerated protocol of Ponseti method was suggested to shorten the period of treatment of the conventional one for the cases of talipes equinovarus deformity. This study aimed to compare the accelerated protocol of Ponseti method in the treatment of clubfoot deformity with the conventional one.

Methods: A prospective comparative study was conducted for infants less than six months with congenital talipes equinovarus deformity. The patients were randomized to either Group 1 (casts changed every week, conventional protocol of Ponseti method) or Group 2 (twice weekly, accelerated one). Pirani score was used to assess the severity of the deformity at presentation, at time of last cast removal, and at the last follow up visit (6th months).

Results: The patients included were 48 cases with 79 feet. Group 1 (39 clubfeet) had a mean Pirani score of 5.6 (± 1.15) at presentation, which dropped to 0.47 (± 0.41) when the last cast was removed. In Group 2 (40 clubfeet), it dropped from 5.57 (± 0.83) to 0.77 (± 0.01). The result of each treatment protocol was significant, but the difference between them was not significant. Five cases (three patients aged more than three months) of Group 2 needed eight casts to reach an acceptable position of correction. The difference between the mean number of casts applied in Group 1 (5.09) and Group 2 (5.82) was statistically not significant. However, the difference between the mean number of days spent in the cast was significant. The complications occurred in 12 out of 79 feet, with no statistically significant difference between both groups.

Conclusion: The accelerated protocol of Ponseti method for treating clubfoot deformity is as effective and as safe as the conventional one. It shortens the time required to complete the treatment program. Those who present lately (beyond the age of three months) may require an additional number of casts.

References

Gibbons PJ, Gray K. Update on clubfoot. J Paediatr Child Health 2013; 49(9):E434–7.

Dobbs MB, Gurnett CA. Update on clubfoot: etiology and treatment. Clin Orthop Relat Res 2009; 467(5):1146–53.

Morcuende JA, Dolan LA, Dietz FR, Ponseti IV. Radical reduction in the rate of extensive corrective surgery for clubfoot using the Ponseti method. Pediatrics 2004; 113:376–80.

Herzenberg JE, Radler C, Bor N. Ponseti versus traditional methods of casting for idiopathic clubfoot. J Pediatr Orthop 2002; 22:517–21.

MacNicol M. The management of club foot: issues for debate. J Bone Joint Surg Br 2003; 85-B:167–70.

Zwick EB, Kraus T, Maizen C, Steinwender G, Linhart WE. Comparison of Ponsetiversus surgical treatment for idiopathic clubfoot: a short-term preliminary report. Clin Orthop Relat Res 2009; 467(10):2668–76

Siapkara A, Duncan R. Congenital talipes equinovarus: A review of current management. J Bone Joint Surg Br 2007; 89:995–1000.

Harnett P, Freeman R, Harrison WJ, Brown LC, Beckles V. An accelerated Ponseti versus the standard Ponseti method: A prospective randomized controlled trial. J Bone Joint Surg Br 2011; 93:404–8.

Sharma P, Yadav V, Verma R, Gohiya A, Gaur S. Comparative analysis of results between conventional and accelerated Ponseti technique for idiopathic congenital clubfoot. Orthop J MP 2016; 22:3–7.

Morcuende JA, Abbasi D, Dolan LA, Ponseti IV. Results of an accelerated Ponseti protocol for clubfoot. J Pediatr Orthop 2005; 25:623–6.

Ullah S, Inam M, Arif M. Clubfoot management by accelerated Ponseti technique. RMJ 2014; 39:418–20.

Sutcliffe A,Vaea K, Poulivaati J, Evans AM. ‘Fastcasts’:Evidence based and clinical considerations for rapid Ponseti method. Foot Ankle Online J 2013; 6:2.

Solanki M, Ajmera A, Rawat S. Comparative study of accelerated Ponseti method versus standard Ponseti method for the treatment of idiopathic clubfoot. J Orthop Traumatol Rehabil 2018; 10:116–9.

Sahu B, Rajavelu R, Tudu B. Management of idiopathic congenital talipes equinovarus by standard versus accelerated Ponseti plaster technique: A prospective study. J Orthop Traumatol Rehabil 2015; 8:30–4.

Ahmad AA, Aker L. Accelerated Ponseti method: First experiences in a more convenient technique for patients with severe idiopathic club feet. Foot Ankle Surg 2019; 26(3):254–57.

Barik S, Nazeer M, Mani BT. Accelerated Ponseti technique: Efficacy in the management of CTEV. Eur J Orthop Surg Traumatol 2019; 29(4):919–24.

Elgohary HS, Abulsaad M. Traditional and accelerated Ponseti technique: A comparative study. Eur J Orthop Surg Traumatol 2015; 25(5):949–53.

Published
2021-04-27
How to Cite
Doski, J., & Jamal, B. (2021). Accelerated versus conventional Ponseti protocol for the treatment of idiopathic talipes equinovarus deformity: A short term follow up in Iraq. Zanco Journal of Medical Sciences (Zanco J Med Sci), 25(1), 473-479. https://doi.org/10.15218/zjms.2021.009
Section
Original Articles