Clubfoot, also called as “Congenital talipes equinovarus” or “CTEV”. It is idiopathic and one of the commonest congenital conditions. It is a severe anomaly of foot, needs to be corrected. Nicolas Andry (1743), described the term “Pedis Equinal” in his “Orthopaedicia” which means foot of the horse. The term “Talipes Equinovarus” is derived from Latin language, Talus means ankle, Pes means foot and equinus means horse like (plantar flexed) and varus means adducted and inverted. 1

The incidence of congenital talipes equinovarus is 1-2 per thousand live birth totaling around 100000 baby is born with this deformity every year, among which 80% are born in developing nations 2,3. There are studies mentioning that the incidence of clubfoot is increasing, making it a challenge for us to treat it with more specific and accurate methods. Gartland’s famous observation of clubfoot in 1964 was “We are still crippling with a problem the cause of which is not known, the pathological anatomy of which is uncertain, the behavior of which is uncertain and the treatment of which remains controversial” 4, This stands good even today.

The congenital clubfoot is a complex three-dimensional deformity having four components: equinus, varus, adducts, and cavus.5. We reserve the term supination for combined movements of adduction, flexion, and inversion, and the term pronation for combined movements of abduction, extension, and eversion. The term heel varus is used for movements of inversion and adduction of the calcaneus, and the term heel valgus is used for eversion and abduction of the calcaneus. The term forefoot supination is used for movements of inversion and adduction of the forepart of the foot and the term forefoot pronation is used for eversion and abduction of the forepart of the foot. Equinus refers to an increased degree of plantar flexion of the foot. Cavus refers to the increased height of the vault of the foot. The purpose of the treatment of CTEV is to reduce the deformities with painless functional plantigrade foot with good mobility without any modified shoes and within cosmetically acceptable limits. The recent trend for clubfoot treatment includes series manipulation, stretching, immobilization, and for the relapse and resistant cases management includes soft tissue releases osteotomy immobilization.

The methods described by J.H. Kite, Ignacio V. Ponseti and French are conservative. Amongst these, the technique described by Ignacio V. Ponseti which includes gradual and sequential correction of all deformities by manipulation and immobilization with cast at about weekly interval gained maximum popularity.

So the study of correction of clubfoot deformity by Ponseti techique is done to analyze its effectiveness and functional outcome in children below one year of age and without any prior treatment for the same.

Our prospective study is a series of 60 cases of CTEV treated by Ponseti method at Department of Orthopedics in Chigateri Government Hospital, Davangere and Bapuji Hospital, Davangere attached to JJM Medical College, Davangere during the period of from December 2022 to April 2025. Patients will be followed up regularly every week during treatment and monthly after the completion of treatment. The severity of foot deformities will be graded as per Pirani’s scoring system.

SOURCE OF DATA:

Patient of both sexes less than 1 year age group in general population presenting with congenital talipes equino varus to the Orthopedic Department of Bapuji Hospital and Chigateri General hospital attached to J.J.M. Medical College, Davangere.

METHOD OF COLLECTION OF DATA:

Sample Size:

Minimum 60 pediatric patients less than 1 year of age with CTEV who are willing for treatment during the period of study. They are clinically evaluated. Informed and written consent of the pts parents/guardians will be taken .

Inclusion criteria:

1. Children less than 1 year of age with idiopathic clubfoot
2. Patients who are willing to follow up in our department

Exclusion criteria:

1. Patients aged more than 1 year of age
2. Neglected, Relapsed club foot.
3. Patients who are          unfit      and        noncompliant    to            the         described technique.
4. Patients that have undergone prior surgical intervention for clubfoot
5. Patients who refused

The present study consists of 60 cases of CTEV Corrected by Ponseti Technique. The study period was from December 2022 to April 2025.

Table 1: Sex Distribution

Table 2: Table Showing Side Affected

Table 3: Incidence of Positive Family History

Table 4: Mobility of Foot

TABLE 5: SHOWING PRETREATMENT PIRANI SCORES (According To Pirani)

Table 6: Need for Tenotomy among Different Groups

Table 7: Number of Casts

Table 8: Compliance with Dennis Browne Splint

Table 9: Showing Recurrence of Treated Foot

Table 10: Complications

Table 11: Results of Treatment at Final Follow Up

• Patients were labeled as having a good result if all deformities get corrected by Ponseti technique alone at final follow up
• However, if Ponseti technique failed to give complete correction of foot, such patients were kept under fair result.
• In the present study about 90% of patients showed good results and about 10 % had Fair result.

A clinical study on one of the most common congenital deformities of foot i.e. Congenital talipes equinovarus was carried out in Department of Orthopedics, JJMMC, Davangere to evaluate the early results of the conservative treatment using Ponseti technique. In total, there were thirty children (Ninty feet) treated by Ponseti technique.

In our study there were 40 males and 20 female children that is 66.66% and 33.33% respectively. Incidence of males and females in our series is not very different from other reported series. Kite in the series of 1509 cases reported 70% males and 30% females.

As regards laterality, 30 of our cases were bilateral (50%) and 30 were unilateral (50%) (14 right and 16 left sided) which is in concordance with other series presented by Wyne Davis (44% bilateral and 56% unilateral).6 Chung reported bilaterality in 55.75% of cases. Turco reported bilaterality in 56.76% cases.7

In the present study positive family history was ascertained in 16.66% of patients. However, review of literature revealed that the percentage of positive family history varies between 5 to 50%. Similar incidence of 17.9% of positive family history has been observed by Turco.7

In the present study clubfoot deformity was classified, according to the Pirani scoring system into 3 groups. Group-I with a Score of 1.5 to

2.5 points was seen in four feet (8.9%), Group-II the most common category, with a Score of 3 to 4.5 points was seen in 50 feet (55.6%) and group-III with a Score of > 5 points was seen in sixteen

feet (35.6%). Overall mean Pirani Score of 4.35 was recorded for all feet. Similarly mean Pirani Score of 4.6 was noted by Lehman et al. We found that those feet belonging to Group I and II were more amenable to correction and responded relatively early when compared to those belonging to Group III.

In the present study the mean number of casts that were applied to obtain correction in group I, II and III were 4.75, 7.2 and 9.06 respectively. The more severe the initial deformity, the more casts were required to obtain correction. However overall mean number of cast for all groups was 7, which is quite similar to Laaveg and Ponseti and Herzenberg et al. who reported mean number of cast as 7.

In our study, 18(60%) patients required Percutaneous Tenotomy of Tendo Achilles. In Morcuende et al. study (n=256) tendoachilles tenotomy was done is 86% ofthe cases.In M Changulani et al.

study,85% (n=100) patients required percutaneous tenotomy of Tendo Achilles. Most important observation noted from this study is the recognition that feet requiring tenotomies were equally well corrected clinically at the end of casting as those that did not require tenotomies. This conclusion reinforces the notion that even severe idiopathic clubfeet can be successfully treated using proper application of the Ponseti technique and the need for a tenotomy does not suggest a poorer result.

Ponseti Method is an excellent conservative method for treatment of Congenital Talipes Equino Varus (CTEV) deformity. Treatment must be started at the earliest possible age. Number of casts required to achieve full correction increases as the age at presentation increases. The patients who have lower Pirani score at initial visit (i.e. less severe deformity) respond better and faster to the treatment as compared to those who have higher Pirani score at initial visit (i.e. more severe deformity). Strict adherence to the casting technique helps in successful correction and to minimize complications. Early results of treatment of Idiopathic CTEV by Ponseti technique results in good correction of the deformity with minimal surgery i.e. tenotomy of Tendo Achilles. Maintenance of the corrected deformity with molded orthosis is as important as deformity correction, parent motivation & compliance is very important for successful management of the deformity. Duration of the study is not sufficient to predict the long-term results but early results are certainly encouraging.

1. Cartlidge I. Observations on the epidemiology of club foot in Polynesian and Caucasian populations. Journal of medical genetics. 1984 Aug 1;21(4):290-
2. Chung CS, Nemechek RW, Larsen IJ, Ching GH. Genetic and epidemiological studies of clubfoot in Hawaii. Human heredity. 1969;19(4):321-42.
3. Cowell HR, Wein BK. Genetic aspects of club foot. JBJS. 1980 Dec 1;62(8):1381-4.
4. Yamamoto H. A clinical, genetic and epidemiologic study of congenital club foot. Japanese Journal of Human Genetics. 1979 Mar 1;24(1):37-44.
5. Yang H, Chung CS, Nemechek RW, Rao DC. A genetic analysis of clubfoot in Hawaii. Genetic epidemiology. 1987 Jan 1;4(4):299-306.
6. Wyne-Davies, Ruth. Talipes Equinovarus. A review of eighty four cases after completion of the treatment. J Bone Joint Surg 1964; 46-B: 464- 476.
7. Turco VJ. Clubfoot, Churchill Livingstone, 1981:1 -84