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Journal of Bone and Joint Surgery - British Volume, Vol 88-B, Issue 10, 1385-1387.
doi: 10.1302/0301-620X.88B10.17578  
Copyright © 2006 by British Editorial Society of Bone and Joint Surgery
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Treatment of idiopathic club foot using the Ponseti method

INITIAL EXPERIENCE

M. Changulani, MS, MRCS, Clinical Fellow1; N. K. Garg, MS, MCh(Orth), Consultant Orthopaedic Surgeon (Locum)2; T. S. Rajagopal, MRCS, MS, Specialist Registrar3; A. Bass, FRCS(Orth), Consultant Orthopaedic Surgeon2; S. N. Nayagam, FRCS(Orth), Consultant Orthopaedic Surgeon2; J. Sampath, MSc, FRCSEd(Trauma & Orth), Consultant Orthopaedic Surgeon2; and C. E. Bruce, FRCS(Orth), Consultant Orthopaedic Surgeon2

1 Salford Royal NHS Trust, Hope Hospital, Stott Lane, Salford M6 8HD, UK.
2 Royal Liverpool Children’s NHS Trust, Alder Hey, Eaton Road, Liverpool L12 2AP, UK.
3 Ealing Hospital NHS Trust, Uxbridge Road, Southall, UB1 3HW, UK.

Correspondence should be sent to Mr N. K. Garg; e-mail: nkgarg23{at}hotmail.com

We report our initial experience of using the Ponseti method for the treatment of congenital idiopathic club foot.

Between November 2002 and November 2004 we treated 100 feet in 66 children by this method. The standard protocol described by Ponseti was used except that, when necessary, percutaneous tenotomy of tendo Achillis were performed under general anaesthesia in the operating theatre and not under local anaesthesia in the out-patient department. The Pirani score was used for assessment and the mean follow-up time was 18 months (6 to 30).

The results were also assessed in terms of the number of casts applied, the need for tenotomy of tendo Achillis and recurrence of the deformity. Tenotomy was required in 85 of the 100 feet. There was a failure to respond to the initial regimen in four feet which then required extensive soft-tissue release. Of the 96 feet which responded to initial casting, 31 (32%) had a recurrence, 16 of which were successfully treated by repeat casting and/or tenotomy and/or transfer of the tendon of tibialis anterior. The remaining 15 required extensive soft-tissue release. Poor compliance with the foot-abduction orthoses (Denis Browne splint) was thought to be the main cause of failure in these patients.




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Registered charity no: 209299     Print ISSN: 0301-620X
Hip, Knee, Trauma, Upper limb, Foot & Ankle, Paediatrics, Oncology, Spine, Arthroplasty, General