The use of Ponsetis technique in achieving correction of clubfoot that has failed with Kites method

1
The use of Ponsetis technique in achieving
correction of clubfoot that has failed with
Kites method
Dr.Durga Kowtharapu, Dr Thomas Kishen, Dr. Ajoy
Shetty, Dr.S.Rajasekaran Ganga Hospital,
Coimbatore, India
83 Good results Failure in 3 foot 2 foot with
residual equinus was treated with revision
tenotomy and cast for 6 weeks. One foot with
complete relapse treated with Posteromedial soft
tissue release.
Background of the Study

• Kites method is one of the common method still
  practiced to treat clubfoot in many developing
  countries.
• Viewing cases like this, which was failed with
  Kites method is not uncommon in developing
  countries.
• Untill now surgery is the only option to treat
  these cases.
• Since last decade Ponsetis method is
  popularised because of high success rate and less
  recurrence.

Case no 1
Age- 5 months Previously Underwent 4 Kites Casts
MFCS 2.5, HFCS 3 Total Score 5.5
Aim of the study
To find the efficacy of the Ponsetis method in
the correction of clubfoot that has failed with
Kites method.
Materials and methods

• Prospective study
• 13 Children with 18 Idiopathic clubfoot were
  included in the study.
• Male Female 94. Unilateral Bilateral
  85
• Average age - 8.3 months (range 3 months 18
  months
• All children previously underwent Kites casting
  and presented with residual deformities.
• The severity of the deformities were assesed
  using Piranis 6 point scoring system.
• All the children underwent five serial cast
  application
• 14 clubfoot percutaneous tenotomy of
  Tendoachilles performed under Local anaesthesia
• We advised regular wear of Dennis Brown splint
  for 6 months and advised to continue only at
  nights till 4 yrs.

6 months Follow-up
Before Cast
Case no 2
Age- 1 year 3 months Previously Underwent 5
Kites Casts MFCS 3, HFCS 3 Total Score 6
Before Cast
8 months Follow-up
Conclusions
Results at the end of One year

• Ponsetis method can be safely used to correct
  resistant and relapsed clubfoot in children who
  has failed to respond with Kites method
• Early Recurrence of equinus deformity after
  achieving full correction can be successfully
  corrected with revision percutaneous tenotomy of
  tendoachilles and cast application for 6 weeks.
• It is still worth to try this method even in
  stiff foot before performing extensive soft
  tissue procedures.
• Use of this technique will significantly reduce
  the problems of extensive early surgical
  interventions.

TS- Total score, HFCS Hindfoot contracture score
MFCS-Midfoot contracture score