Ponseti Method versus Posteromedial Soft Tissue Release for the Management of Clubfoot: A Prospective Interventional Study

摘要

Idiopathic clubfoot is a common complex deformity of newborns that can be managed either by manipulation, serial casting or by surgery with individualised success of treatment rated differently.Aim: To determine functional outcome, health status of clubfoot patients and the percentage of recurrence that needs additional surgery at the end of three years of treatment by using both Ponseti and posteromedial soft tissue release method.Materials and Methods: A prospective interventional study was conducted in which two groups of idiopathic clubfoot patients were treated as per the two modalities of treatment (ponseti versus posteromedial release) at the Orthopedic Department of Veer Surendra Sai Institute of Medical Science and Research, Odisha, India between March 2017 to February 2021, with regular follow-up to a period of three years. Forty patients with 63 feet were taken in the study. Out of which 20 patients with 32 feet were managed by ponseti method in one group where as another group containing 20 patients with 31 feet were treated by posteromedial soft tissue release. During follow-up foot function was assessed by Laaveg-Ponseti score, general well being of the children was assessed by paediatric outcomes data collection instrument and any complications were recorded in terms of recurrence.Results: Mean age of presentation in Ponseti group is 4.73 month, whereas mean age of presentation in surgical group is 7.85 month. Though recurrence was the major complication in both the groups, significant difference was seen in severity of recurrence (p-value=0.049). More numbers of major recurrence were seen in posteromedial surgical group (5,16.13%) which subsequently required major surgical procedures for correction. Pretreatment pirani score of ponseti and surgical group (4.9±1.0, 5.1±0.90) was statistically improved (0.34±0.38, 0.20±0.33). Foot function was evaluated using Functional Rating System (FRS) total score showing higher in ponseti group 95.25±5.68 with good to excellent outcome. Health status of the patients was assessed by Paediatric Outcomes Data Collection Instrument (PODCI) score, showed no significant difference in result in both the groups (p-value=0.3562) in view of global function subscale.Conclusion: This study have documented a favourable outcome towards ponseti group in terms of higher rate of excellent to good outcome, better parental satisfaction and better passive mobility of clubfeet with less number of revision surgery required for recurrence.