Background

Congenital idiopathic clubfoot is

difficult to correct.
It has 4 components : ankle equinus,
hindfoot varus, forefoot adductus,
midfoot cavus
Goal of treatment : reduce all
components obtain functional &
cosmetically aceptable fot within
minimun duration of therapy.

cont
The initial treatment should be nonoperative.
But, it has only 15%-50% of long-term
success rate, except the Ponseti method.
The Ponseti includes srial manipulatives,
cast application, and percutaneus Achilles
tenotomy.
Shot-term success rate of this method is
90%, the mid-term to long-term is equally
impressive.

Purpose
Evaluate the mid-term effectiveness
of the Ponseti method for the
treatment of congenital idiopathic
clubfoot.

Materials and Methods

49 pasien menjalani terapi Ponseti oleh
seorang dokter Ortopedi selama periode
Oktober 2003 Juli 2007.
Pada Juli 2010 seluruh pasien dipelajari oleh
peneliti dengan rata2 periode follow up 5 th
Penilaian klinis meliputi: insidensi deformitas
rekuren dan residual, range of movement
pasif (dengan goniometri), penampilan,
kekuatan otot, atrofi betis, ukuran kaki,
komplikasi lain

 Penilaian Fungsional :
Cara berjalan
Keterbatasan fungsional
Nyeri
Kepuasan pasien

Penilaian menggunakan sistem skor

Ponseti
Kaki normal memiliki skor 100 90100 sangat baik, 80-89 baik, 70-79
cukup, < 70 buruk

Treatment Regiment
The Ponseti gentle manipulation on the foot,
and serial application of long leg plaster cast
(weekly) without anesthesia.
Cavus is corrected by supinating the forefoot,
dorsiflexing 1st metatarsal.
If failed abducting the supination
Long leg cast changed weekly after proper
manipulation.
If residual equinus observedafter the aduction of
foot percutaneous tenotomy performed on
achilles tendon.

cont
Denis-Browne splint is used to prevent
relapse deformity.
The Ponseti apply this splint 23 hrs/day for
3 months and then at night (12-14 hrs) for
3 years.
The parents instructed to perform ROM
exercise for ankle & foot.
The exercise performed twice a day till
weigt bearing age and 5 times/day for he
nxt 3 years.

Results
49 patients (39 male, 10 female) with 67 club feet
were treated for mean of 5 yrs.
18 patients had bilateral club foot, 17 unilateral
(right foot), 14 unilateral (left food).
17 children (34 clubfeet) out of 18 patients with
bilateral clubfoot had Pirani severity score of six, and
one children (2 clubfeet) had a Pirani score of five.
In unilateral group the mean Pirani score was 5.83
(range 5-6).
The mean Mid Foot Score and Hind Foot Score was
2.8 (range 2.5-3) and 2.76 (range 2-3)

..cont
47 children (95.91%) needed
percutaneus tenotomy, 18 in
bilateral group and 29 in the
unilateral group.
The mean Mid Foot Score and Hind
Foot score for the entire group at the
time of tenotomy was 0.5 and 2.5
respectively.

Event of Relapse Deformity (14 patients)

 At the mean of five year follow-up, 44

patients (89.79%) had normal passive
range of motion (58 clubfeet - 86.56%).
Parents of 32 patients (65.30%) accept
the look of the clubfoot nearly normal
and parents of 12 patients (24.49%)
accept the look of clubfoot as normal.
44 patients (89.29%) had a good to
excellent at mean five year of follow up.

Discussion
Extensive open surgery like postero-medial
release is commonly associated with longterm stiffness and weakness which is avoided
by the Ponseti technique.
The Ponseti treatment of clubfoot has three
phases
the corrective phase involves application of casts,
the maintenance phase where splint fitting is
emphasized,and
the transition phase where the splints are
discontinued and regular foot wear allowed.

 There are three main issues which

lead to inferior results with this
technique:
splint compliance,
splint fitting
under correction of the ankle equinus.

Conclusion
Researchers evaluate mid-term results for
congenital idiopathic clubfoot treated by
Ponseti method and are satisfied with the
outcome at mean five year of follow-up.
Documentation of the long term results of
the technique when it has been used by
orthopedists were still lack despite the
92-98% successful short-term results that
reported.