TREATMENT OF THE VARUS EQUIN CLUB FOOT WITH PONSETI METHOD MALIAN EXPERIENCE

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TREATMENT OF THE VARUS EQUIN CLUB FOOT WITH
PONSETI METHOD MALIAN EXPERIENCE
Tounkara Nouhoum dit Baba, OrthoproSthesist CNAOM
Bamako Mali April 2009
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Definition  

• Reminder the club foot, also called , equin
  varus club foot, is an abnormality of the foot
  growth that happens during the fetus period. It
  is a congenital deformity (that is existing
  since the birth of the child)
• The club foot is the most frequent cause of the
  congenital locomotion system deformity
• Le taux de prevalence rate in developped
  countries is 1/1000 births
• In Austrich 8,7 cases over a 1000
• In Mali, the rate is not known but with 80 of
  the population living in poverty a physical
  disability related to club foot is an aggravating
  factor

Aspect of the foetus at 7 months
At birth
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The pilot project - its objective

• The pilot project for club foot care has been
  initiated in October 2006 in the frame of the
  Mali- Austrich coopération.
• Based on a progressive transfer system, its
  application has been done via a series of
  theoretical and practical trainings of the CNAOM
  technical staff and other doctors from other
  partnering health centres
• The project is supervised by an austrian
  technical team that ensures regular technical
  training
• The objective of the project is  to revent the
  effects of the congenital club foot throughout
  the Malian territory with a precocious treatment
  

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Theoretical training

• It targetted the
• 1. Definition of the equin varus congenital club
  foot (seen above)
• 2. Explanation of the seriousness of the score of
  Pirani evaluated between three values that are
• 0 Normal
• 0.5 Slightly abnormal
• 1 Very abnormal
• 3. Clinic Signs two types
• lower foot (Score of the mid foot)
• curving of the lateral side
• median furrow
• Cover of the talus
• back pied (Score of the back foot)
• Back furrow
• Fixed equin
• Vacuity of the ankle

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Practical training

• It targetted the
• Evaluation and classification of the score of the
  mid foot and the back foot
• 2. Plastering correction of the equin varus foot
  according to the Ponséti method with CNAOM, CHU
  ( Gabriel Touré and Kati), PMI (maternal and
  infantile prevention ) , regional hospitals
  (Kayes, Sikasso, Ségou, Gao, Tombouctou)
• 3. Percutaneous Tenontotomy of the Achilles
  tendon in health centres like CNAOM, CHU of Kati
  and HR of Tombouctou
• 4. Attended by all actors

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Evaluation of the score of the mid foot

• Three signs are taken into account in the
  classification of the mid foot making the grading
  of its deformity from 0 to 3 possible

• Lateral side curving 1
• median senew 2
• Cover of the Talus head 3

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Evaluation of the back foot score

• Three signs are taken into account in the
  classification of the back foot just like the mid
  foot making the grading of its deformity from 0
  to 3 possible

• Back senew (1)
• Fixed equin (2)
• Vacuity of the ankle (3)

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Plastering correction of the equin varus foot
according to the Ponséti method

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Phases of the plastering correction process