FUNCTIONAL OUTCOME OF THE RESULTS OF PONSETI MANAGEMENT OF CLUB FOOT AFTER WALKING AGE: A STUDY IN SHAHEED ZIAUR RAHMAN MEDICAL COLLEGE HOSPITAL, BOGURA, BANGLADESH

Md. Nazrul Islam*, Md. Mohiuddin Aslam, Md. Masudur Rahman and Md. Salimullah Akand

ABSTRACT

Background: Clubfoot is the commonest congenital deformity in babies. More than 100,000 babies are born worldwide each year with congenital club foot. Around 80% of cases occur in developing nation. Objective: To assess the outcomes of congenital clubfoot by Ponseti technique after walking age. Methods: This prospective interventional study was conducted in the outpatient department of Shaheed Ziaur Rahman Medical College, Bogura, Bangladesh from January 2018 to December 2019 for duration of two years. All congenital clubfoot patients, age more than 18 months (Walking age group) of both sexes were included in this study. A total number of 30 patients were enrolled in this study as per inclusion and exclusion criteria. Diagnosis of the congenital telipes equinovarus deformity was made by history and clinical examination. Treatment was given according to Ponseti technique and correction of deformity was determined by Dimeglio scoring system. Results: 30 patients with 41 clubfeet were treated and followed up for this study. Both rigid and non rigid varieties of club feet were treated irrespective of sex and side of involvement. Dimeglio scoring system was used to evaluate result. Among 30 patients 18(60%) were male and 12(40%) were female .The male patients (60%) were more than female (40%). The mean age in the study group was 23.63 ± 4.75 with a range of 19 – 34 months. Family history of clubfoot was present in only 4(13.3%) cases and absent in the rest 26(86.7%) cases. Involvement of right foot was in 14 (46.7%) cases followed by bilateral involvement 11 (36.7%) and left foot was in 5(16.7%) cases among 41 feet 32(78%) were rigid and 9(22%) were non rigid. Tenotomy needed in 36(87.8%) cases. Complication was present in 6(14.6%) cases. The mean Dimeglio scoring of deformities of Equinus was 3.22 ± 0.57 and 1.00 ± 0.63 before and after procedure respectively (p<0.001). The mean Dimeglio scoring of deformities of Varus was 3.60 ± 0.49 and 1.37 ± 0.54 before and after procedure respectively (p<0.001). The mean Dimeglio scoring of deformities of Supination was 3.15 ± 0.62 and 1.05 ± 0.68 before and after procedure respectively (p<0.001). The mean Dimeglio scoring of deformities of Adduction was 3.54 ± 0.55 and 0.90 ± 0.50 before and after procedure respectively (p<0.001). The mean Dimeglio scoring of the affected foot was 17.29 ± 1.87 and 4.32 ± 1.82 before and after procedure (p<0.001) respectively. Conclusion: This study permits to conclude that Ponseti technique for the treatment of club foot after walking age is safe and effective.

Keywords: Club foot management, Dimeglio scoring, Treatment of club, Sex and side of involvement.