Journal of Foot and Ankle Surgery (Asia Pacific)

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VOLUME 12 , ISSUE 1 ( January-March, 2025 ) > List of Articles

ORIGINAL RESEARCH

Can the Age of Initiation of Ponseti Casting Predict the Number of Casts, Duration of Treatment, and Overall Outcomes in the Management of Idiopathic Clubfoot in Infants? A Prospective Cohort Study

Ankit Khurana, Adarsh K Singh, Nandita Joshi, GP Kaushal, Jitender Saini, Himanshu Gupta, Jujhar Singh

Keywords : Adherence, Clubfoot, Compliance, Congenital talipes equinovarus, Foot abduction brace, Ponseti method, Ponseti technique, Recurrence, Relapse

Citation Information : Khurana A, Singh AK, Joshi N, Kaushal G, Saini J, Gupta H, Singh J. Can the Age of Initiation of Ponseti Casting Predict the Number of Casts, Duration of Treatment, and Overall Outcomes in the Management of Idiopathic Clubfoot in Infants? A Prospective Cohort Study. J Foot Ankle Surg Asia-Pacific 2025; 12 (1):11-16.

DOI: 10.5005/jp-journals-10040-1364

License: CC BY-NC 4.0

Published Online: 20-12-2024

Copyright Statement:  Copyright © 2025; The Author(s).


Abstract

Background: The Ponseti method has revolutionized the management of idiopathic clubfoot, and early initiation of casting is recommended for better outcomes. Methods: This prospective study aimed to evaluate the association between the timing of clubfoot casting in infants and treatment outcomes, including the duration of therapy, number of corrective casts, and Pirani score before and after casting. A total of 76 feet in 50 patients with idiopathic clubfoot were divided into two groups based on age: group A (0–1 month) and group B (1–12 months). All patients were managed using the Ponseti method of casting. Results: The mean age of patients was 2.66 ± 2.79 months, and 55.3% of the participants were under one month of age (group A). There was a significant difference between the two groups in terms of duration of treatment (in weeks) and number of casts, with the median number of casts being highest in the age-group over 1 month. Conclusion: The findings of this study support the recommendation to initiate clubfoot casting as soon as medically reasonable, preferably within the 1st month of life, as it leads to good outcomes in terms of duration of therapy, number of corrective casts, and Pirani score before and after casting. However, starting casting beyond one month of age does not appear to adversely affect outcomes, but the number of casts and duration of therapy are less if treatment is started in the 1st month of life. Level of evidence: II.

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  1. Göksan SB, Bursalı A, Bilgili F, et al. 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/s00402-005-0070-9
  2. Pirani S, Naddumba E, Mathias R, et al. Towards effective ponseti clubfoot care: the uganda sustainable clubfoot care project. Clin Orthop Relat Res 2009;467(5):1154–1163. DOI: 10.1007/s11999-009-0759-0
  3. Dobbs MB, Gurnett CA. Update on clubfoot: etiology and treatment. Clin Orthop Relat Res 2009;467(5):1146–1153. DOI: 10.1007/s11999-009-0734-9
  4. Richards BS, Faulks S, Rathjen KE, et al. A comparison of two nonoperative methods of idiopathic clubfoot correction: the Ponseti method and the french functional (physiotherapy) method. J Bone Joint Surg Am 2008;90(11):2313–2321. DOI: 10.2106/JBJS.G.01621
  5. Tindall AJ, Steinlechner CWB, Lavy CBD, et al. Results of manipulation of idiopathic clubfoot deformity in malawi by orthopaedic clinical officers using the ponseti method: a realistic alternative for the developing world? J Pediatr Orthop 2005;25(5):627–629. DOI: 10.1097/01.bpo.0000164876.97949.6b
  6. Ponseti IV. Treatment of congenital club foot. J Bone Joint Surg Am 1992;74(3):448–454.
  7. Ponseti IV, Smoley EN. Congenital club foot: the results of treatment. J Bone Jt Surg 1963;45(2):261–344.
  8. Scanlan E, Grima-Farrell K, IIhan E, et al. Initiating Ponseti management in preterm infants with clubfoot at term age. J Child Orthop 2022;16(2):141–146. DOI: 10.1177/18632521221080476
  9. Agarwal A, Gupta N. Does initial Pirani score and age influence number of Ponseti casts in children? Int Orthop 2014;38(3):569–572. DOI: 10.1007/s00264-013-2155-3
  10. Abbas M, Qureshi OA, Jeelani LZ, et al. Management of congenital talipes equinovarus by Ponseti technique: a clinical study. J Foot Ankle Surg 2008;47(6):541–545. DOI: 10.1053/j.jfas.2008.07.002
  11. Alves C, Escalda C, Fernandes P, et al. Ponseti method: does age at the beginning of treatment make a difference? Clin Orthop Relat Res 2009;467(5):1271–1277. DOI: 10.1007/s11999-008-0698-1
  12. İltar S, Uysal M, Alemdaroğlu KB, et al. Treatment of clubfoot with the Ponseti method: should we begin casting in the newborn period or later? J Foot Ankle Surg 2010;49(5):426–431. DOI: 10.1053/j.jfas.2010.06.010
  13. Ponseti IV, Campos J. Observations on pathogenesis and treatment of congenital clubfoot. Clin Orthop Relat Res 1972;84:50–60. DOI: 10.1097/00003086-197205000-00011
  14. Vaishy AK, Arif M, Acharya D, et al. Influence of beginning time of casting for clubfoot treatment by Ponseti method in different age group infants: a retrospective study. Indian J Orthop 2020;54(1):55–59. DOI: 10.1007/s43465-019-00004-6
  15. Bhaskar A, Patni P. Classification of relapse pattern in clubfoot treated with Ponseti technique. Indian J Orthop 2013;47(4):370–376. DOI: 10.4103/0019-5413.114921
  16. Lebel E, Weinberg E, Berenstein-Weyel TM, et al. Early application of the Ponseti casting technique for clubfoot correction in sick infants at the neonatal intensive care unit. J Pediatr Orthop B 2017;26(2):108–111. DOI: 10.1097/BPB.0000000000000363
  17. Awang M, Sulaiman AR, Munajat I, et al. Influence of age, weight, and pirani score on the number of castings in the early phase of clubfoot treatment using Ponseti method. Malays J Med Sci 2014;21(2):40–43.
  18. Hemo Y, Yavor A, Gigi R, et al. The significance of foot length at the initiation of the Ponseti method: a prospective study. J Child Orthop 2019;13(3):252–257. DOI: 10.1302/1863-2548.13.190075
  19. Lourenço AF, Morcuende JA. Correction of neglected idiopathic club foot by the Ponseti method. J Bone Joint Surg Br 2007;89:378–381. DOI: 10.1302/0301-620X.89B3.18313
  20. Rigo J, Pieltain C, Salle B, et al. Enteral calcium, phosphate and vitamin D requirements and bone mineralization in preterm infants: calcium, phosphate and vitamin D requirements. Acta Paediatr 2007;96(7):969–974. DOI: 10.1111/j.1651-2227.2007.00336.x
  21. Kitazawa S, Itabashi K, Umeda Y, et al. Growth and bone mineralization in small-for-gestational-age preterm infants: growth and BMC in SGA preterm infants. Pediatr Int 2014;56(1):67–71. DOI: 10.1111/ped.12189
  22. Stephan C, Herzenberg JE, Araujo FF. Accurate determination of cast weight for neonates with clubfoot. J Pediatr Orthop 2000;20(2):230–233.
  23. Spiegel DA, Shrestha OP, Sitoula P, et al. Ponseti method for untreated idiopathic clubfeet in Nepalese patients from 1 to 6 years of age. Clin Orthop Relat Res 2009;467(5):1164–1170. DOI: 10.1007/s11999-008-0600-1
  24. Verma A, Mehtani A, Sural S, et al. Management of idiopathic clubfoot in toddlers by Ponseti's method. J Pediatr Orthop B 2012;21(1):79–84. DOI: 10.1097/BPB.0b013e328347a329
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