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Evaluation of the utility of the Ponseti method of correction of clubfoot deformity in a developing nation

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Abstract

Clubfoot is the commonest congenital deformity in babies. More than 100,000 babies are born worldwide each year with congenital clubfoot. Around 80% of the cases occur in developing nations. We treated 154 feet [mean Pirani score (total) 5.57] in 96 children (78 males, 18 females) by the Ponseti method from January 2003 to December 2005. A prospective follow-up for a mean duration of 19.5 months (range 6–32 months) was undertaken. After six months of treatment the Pirani score was reduced to zero for all patients. The results show that corrective surgery, sometimes multiple, can be avoided in most cases which are usually associated with the development of a stiff, painful foot. Low socio-economic status and illiteracy prevailing in developing nations increases the prevalence of neglected clubfoot that is still harder to correct. Integration into various programs and proper use of available resources can decrease neglected clubfoot and improve chances of successful and timely correction of deformity. Bracing constitutes an important part of treatment and proper motivation and education of the parents mitigates the chances of losing correction. The Ponseti method of correcting clubfoot is especially important in developing countries, where operative facilities are not available in the remote areas and well-trained physicians and personnel can manage the cases effectively with cast treatment only.

Résumé

Le pied bot est parmi les déformations les plus habituelles chez l’enfant. Plus de 100.000 enfants naissent chaque année avec un pied bot congénital. 80% des cas proviennent des pays en voie de développement. Nous avons traité 150 cas de pieds avec un score de Pirani moyen de 5.57 chez 96 enfants. 78 étaient de sexe masculin, 18 de sexe féminin. Nous avons utilisé la méthode de Ponseti de janvier 2003 à décembre 2005. Une étude prospective a été réalisée sur une période de 19,5 mois (6 à 32 mois). Après six mois de traitement, le score de Pirani a été réduit à 0 chez tous les patients. Le résultat montre qu’une correction chirurgicale peut être parfois nécessaire dans les cas présentant un pied raide et très douloureux. L’utilisation de toutes les ressources nécessaires permettent de diminuer le nombre de pieds bots négligés et d’améliorer les chances de succès du traitement de cette déformation. Le traitement orthopédique est une part importante du traitement et la motivation et l’éducation des parents augmentent les chances de succès et diminuent les pertes de correction. La méthode de Ponseti est très importante dans les pays en voie de développement (80%) où les conditions opératoires ne sont pas très faciles et nécessitent un personnel entraîné.

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Correspondence to Saurabh Singh.

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Gupta, A., Singh, S., Patel, P. et al. Evaluation of the utility of the Ponseti method of correction of clubfoot deformity in a developing nation. International Orthopaedics (SICO 32, 75–79 (2008). https://doi.org/10.1007/s00264-006-0284-7

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  • DOI: https://doi.org/10.1007/s00264-006-0284-7

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