A Novel Approach of Modified Ponseti Technique for Complex Clubfoot Deformity
A recent study from the Department of Orthopaedics, Sri Aurobindo Medical College, in collaboration with Lady Hardinge Medical College, New Delhi, has shed light on the efficacy of the modified Ponseti technique for the treatment of complex clubfoot deformities in children.
The research, published in the Journal of Clinical Orthopaedics and Trauma (DOI: 10.1016/j.jcot.2018.05.017), presents an evaluation of 27 complex clubfeet in 16 patients at the center. The study’s significance lies in its focus on a modified version of a technique that has become the standard for complex clubfoot cases since its introduction by Ponseti et al. in 2006.
Clubfoot, or talipes equinovarus, is a congenital condition characterized by a twisted foot that appears to be turned inwards at the ankle. Standard treatments typically involve the Ponseti method, which includes gentle manipulation and casting of the foot. However, complex clubfoot deformities have notoriously resisted correction through the traditional Ponseti method, necessitating modified techniques.
Methodology and Findings
Patients with complex clubfoot were thoroughly evaluated using the Pirani score system, which helps measure the severity of the deformity at different stages of the treatment. Detailed records of the number of casts required, instances of Achilles tendon tenotomy, instances of relapse, and potential complications were maintained.
The mean Pirani score at the time of presentation was 5.5741, and the score drastically improved to an average of 0.0556 at the final follow-up. On average, patients required 7.44 casts to achieve complete correction, with all feet requiring a tendo Achilles tenotomy—an incision into the tendon to allow for further correction and positioning.
Interestingly, the study reports a relapse rate of 11.11% in treated feet, which were successfully managed by reapplication of the modified Ponseti method, retenotomy, and casting. The resulting final correction was deemed excellent across all patients.
Discussion and Implications
The study’s lead author, Dr. Pushpvardhan P. Mandlecha, alongside his colleagues, Dr. Rajesh Kumar Kanojia, Dr. Vishal Singh Champawat, and Dr. Arvind Kumar, conclude that the modified Ponseti technique, especially when combined with tendo Achilles tenotomy, is a successful non-invasive intervention for the treatment of complex clubfoot that reduces the need for surgical operations.
Furthermore, their research contributes valuable longitudinal data to the field, with the average follow-up duration being just over 14 months, providing insight into the lasting effects of this modification of the Ponseti method.
Future Directions and Level of Evidence
While this study (Level IV evidence) offers hope and direction for practitioners dealing with complex cases of clubfoot deformity, it also underscores the necessity for more extensive research. Larger-scale studies with diverse patient samples and longer follow-up periods would be invaluable in further establishing the efficacy of the modified Ponseti technique.
Conclusion
This evaluation reflects a small triumph in orthopedic pediatric care, reaffirming the value of the modified Ponseti technique as a frontline treatment for complex clubfoot. Its high success rate and low instance of relapse speak to its potential as a gold standard for cases that have historically been challenging to manage.
For Further Reading and References
The original article detailing the findings of this study can be found with the following reference:
1. Mandlecha PP, Kanojia RK, Champawat VS, Kumar A. Evaluation of modified Ponseti technique in the treatment of complex clubfeet. J Clin Orthop Trauma. 2019 May-Jun;10(3):599-608. doi: 10.1016/j.jcot.2018.05.017. PMID: 31061597; PMCID: PMC6492221.
Interested readers may refer to additional literature for further context:
1. Ponseti IV, Zhivkov M, Davis N, Sinclair M, Dobbs MB, Morcuende JA. Treatment of the complex idiopathic clubfoot. Clin Orthop Relat Res. 2006;(451):171-176. doi: 10.1097/01.blo.0000225761.31975.fc. PMID: 16788408.
2. Göksan SB, Bursali A, Bilgili F, Sivacioglu S, Ayanoglu S. Ponseti technique for the correction of idiopathic clubfeet presenting up to 1 year of age. A preliminary study in children with untreated or complex deformities. Arch Orthop Trauma Surg. 2006;126(1):15-21. doi: 10.1007/s00402-005-0024-8. PMID: 16283342.
3. Matar HE, Bierne P, Bruce CE, Garg NK. Treatment of complex idiopathic clubfoot using the modified Ponseti method: up to 11 years follow-up. J Child Orthop. 2016 Feb;10(1):15-18. doi: 10.1007/s11832-015-0707-x. PMID: 26833334; PMCID: PMC4763152.
Keywords
1. Modified Ponseti Technique
2. Complex Clubfoot Treatment
3. Non-invasive Orthopedic Correction
4. Pediatric Clubfoot Therapy
5. Tendo Achilles Tenotomy Clubfoot