Publication:

Functional outcome of idiopathic congenital talipes equinovarus treated by the Ponseti method: a prospective observational study in a tertiary care hospital

Background Idiopathic congenital talipes equinovarus (CTEV), commonly known as clubfoot, is one of the most common congenital musculoskeletal deformities affecting children worldwide. If untreated, it may result in permanent deformity, gait abnormalities, pain, and lifelong disability. The Ponseti method has become the gold standard for the management of idiopathic clubfoot because it is minimally invasive, cost-effective, and associated with excellent functional outcomes. However, treatment success depends on early presentation, meticulous casting technique, Achilles tenotomy when indicated, and strict adherence to the foot abduction brace protocol.

Methods A prospective observational study was conducted in the Department of Orthopaedics, Government General Hospital, Vijayawada, over a period of 24 months. Thirty children younger than two years with idiopathic CTEV were included. All patients underwent treatment using the standard Ponseti protocol consisting of serial manipulation and casting, percutaneous Achilles tenotomy when required, and maintenance using a foot abduction brace. Demographic characteristics, Pirani score, number of casts, tenotomy requirement, treatment-related complications, recurrence, and functional outcome were evaluated.

Results Thirty patients with 43 affected feet were included. Most patients presented within the first six months of life. The majority of feet required six to seven casts for complete correction, while percutaneous Achilles tenotomy was required in 83.7% of feet. Following treatment, near-normal Pirani scores were achieved in most patients. Excellent functional outcomes were observed in 65.1% of feet and good outcomes in 23.3%, resulting in an overall excellent-to-good outcome rate of 88.4%. Treatment-related complications were minimal and managed conservatively.

Conclusions The Ponseti method is a safe, reliable, and highly effective treatment for idiopathic clubfoot. Early initiation of treatment combined with appropriate Achilles tenotomy and good brace compliance results in excellent functional outcomes while minimizing complications and recurrence. The method should remain the first-line treatment for idiopathic CTEV, particularly in resource-limited healthcare settings.