Naji Ullah Khan, Zahid Askar, Awal Hakeem, Zaff Ar Durrani, Israr Ahmad, Mohammad Ayaz Khan, Faheem Ullah.
Idiopathic congenital clubfoot: our experience with the Ponseti method of treatment.
Pak J Surg Jan ;26(1):70-4.

Objective of this study was to present our experience with the Ponseti method in correcting idiopathic clubfoot deformity. Patients and methods: Th is study was conducted in the Orthopaedic Unit of Khyber Teaching Hospital, Peshawar from April 2007 to December 2009. Th e study was conducted on 149 patients with 223 clubfeet. Severity of the deformity was graded into 4 grades according to the grading system of Dimeglio et al. All the patients were managed by ponseti method according to the standard protocol. All the patients were followed up regularly till the age of three years. At the last follow up, all feet were reassessed for correction by the Dimegilo grading system. Eight patients with 13 clubfoot were lost to follow up and the study was completed on 141 patients with 210 idiopathic clubfeet. Results: Out of 141 patients, 85 (60.3%) patients were male and 56 (39.7%) were female. Bilateral foot involvement was in 69 (48.9%) patients, right foot was involved in 40 patients and left foot was involved in 32 patients. Mean age at initial casting was 4.5 weeks, mean number of casts applied were 5.1. Mean duration of casting was 3.0 months. Grade I deformity was present in 59 (28.0%) patients, grade II in 78 (37.1%) patients, grade III in 51 (24.3%) patients and grade IV deformity was present in 22 (10.5%) patients. Percutaneous tenotomy was performed in 201 (95.7%) of clubfeet at an average age of 2.5 months. 199 of 210 clubfeet were successfully corrected, 11 patients developed relapse, 4 patients needed operative treatment to achieve correction. No child had acute complication from conservative or operative treatment. Conclusion: Th e Ponseti method is a safe and eff ective method of treatment for congenital idiopathic clubfoot, it has markedly reduced the need for the operative treatment and the complications associated with operative treatment and other forms of nonoperative treatment. Long term results of our study are awaited.

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