Introduction:
Dr. Ponseti has changed the world of Orthpaedics by showing physicians around the world how to treat congenital clubfoot in a safe, minimally invasive, foot-friendly, and highly effective way. This is a preliminary report of the results of Ponseti method since its introduction at Assiut University Hospital, Egypt, early in 2006.
Material and Methods:
A total of 254 patients (405 clubfeet, including 30 with arthrogryposis, 25 with Myelo-meningocele and 6 with sacral agenesis) have been treated with Ponseti method and studied prospectively by a single orthopedic surgeon since 2006 at our institution. Of these, 321 feet (202 patients) reached full correction and received an abduction brace. Mean follow-up was 10.6 months (1 month to 5.8 years). The mean age at the initiation of the treatment was 5.3 months. Pirani Score averaged 4.5/6. 190 feet were previously untreated, 102 had received non-Ponseti casts, and 20 had been operated upon. Number of casts averaged 4. Local abduction braces were used until recently; the Bangla Brace was introduced through a donation from Walk for Life, Bangladesh. Necessary surgical interventions were recorded. Results at latest follow-up visit were evaluated and recorded as either satisfactory (plantigrade & flexible foot, valgus heel, little/no dynamic supination) or unsatisfactory.
Results:
281 feet (87.5%) were satisfactory at the latest follow-up visit (mean 10.6 months). Achilles tenotomy was done in 204 feet (63.5%) only. Ninety-two feet (28.7%) relapsed and were remanipulated, while 13 underwent Tibialis anterior transfer, and 2 needed a midfoot osteotomy. Compliance to bracing was poor.
Conclusion:
Ponseti method shows promising results in Assiut, Egypt. Further investigation of the considerably low Achilles tenotomy rate is underway. Access to cheap & well-made braces might improve compliance.