Efficacy of Ponseti Casting in Syndromic Clubfoot Cases in Children: A Quasi-Experimental Study

Abstract

Objective: This study aimed to assess the efficacy of Ponseti casting in the management of syndromic clubfoot deformities. Study design: A quasi-experimental study. Place and Duration: This study was conducted in Liaquat College of Medicine and Dentistry, Darul Sehat Hospital Karachi from December 2022 to December 2023. Methodology: Children under one year of age, regardless of gender, with syndromic clubfoot and without prior casting or surgical interventions, were included. Exclusion criteria comprised prior treatment, parental reluctance, or specified conditions. Initial assessments included photographic documentation and Pirani scoring before casting initiation. Weekly casting sessions were documented, with selective TA tenotomies performed when necessary prior to the final cast. Post-treatment documentation and Pirani scoring were conducted, with follow-up assessments at 3 and 6 months to monitor recurrence and surgical requirements. Data analysis was conducted using SPSS version 26. Results: The study enrolled 100 children (70 males, 30 females) with 80 bilateral and 20 unilateral clubfeet. Initial Pirani scores indicated significant deformity, necessitating varying numbers of casts and occasional tenotomies. Despite challenges, notable improvement was observed, although syndromic cases required a greater number of casts compared to idiopathic clubfeet. The mean pre-Ponseti Pirani score was 4.1±0.83, demonstrating a significant reduction to 2.1±0.6 post-treatment (p < 0.001). Recurrence occurred in 40 (40%) children, with 20 (20%) requiring surgical intervention. Conclusion: Ponseti casting demonstrates utility in correcting syndromic clubfoot deformities, albeit with increased casting requirements. Despite the challenges, the method effectively corrects deformity to a considerable extent. Therefore, it is recommended for use in children.