Objective: The study was to evaluate the outcome of accelerated ponseti cast technique for clubfoot at the tertiary care hospital, GMC Jammu india.

Methodology: We conducted a prospective randomised controlled trial to study the results of an accelerated ponseti twice-weekly casting method for the treatment of idiopathic congenital talipes equinovarus at tertiary care hospital from June 2016 to October 2018. A total of 40 patients (57 feet) were included in the study. Patient’s feet were scored according to modified Pirani scoring system. On each cast removal, improvement in Pirani score was noted. Primary outcome measure was deformity correction.

Results: Total 40 patients with 57 clubfoot include in our study There were 27 males (67.5%) and 13 (32.5%) females. Bilateral deformity was present in 17(42.5%) patients where as 23 (57.5%) patients had unilateral clubfoot. Average Pirani score before casting was 4.69 (3.5-6). Average Pirani score post-treatment was 0.48. The average number of cost applied was 5.14 (4-7) .Out of 57 feet, tenotomy was done to 53 feet (92.98%). The average time required for correction from onset of ponseti cast till correction of equinus is 15.5 days (11–20 days). Out of 57 feet, 52 feet (91.22%) were treated successfully using the accelerated Ponseti method.

Conclusions: A twice-weekly Ponseti casting protocol enables completion of the casting period earlier than the standard Ponseti method.

1. Dobbs MB, Gurnett CA. Update on clubfoot: etiology and treatment. Clinical orthopaedics and related 
 2009; 467(5):1146. https://doi.org/10.1007/s11999-009-0734-9 PMID: 19224303 

2. Davies RW. Family studies and the cause of congenital club foot, talipes equinovarus, talipes calcaneo- 
valgus and metatarsus varus. J Bone Joint Surg Br 1964; 46:445–63. PMID: 14216453 

3. Ponseti IV. Congenital clubfoot: fundamentals of treatment: Oxford University Press, USA; 1996. 

4. Simons GW, Sarrafian S. The microsurgical dissection of a stillborn fetal clubfoot. Clinical orthopaedics and related research. 1983; 173:275–83. 

5. Mckay DW. New concept of and approach to clubfoot treatment. Journal of Pediatric Orthopaedics. 1982; 2(4):347–56. PMID: 7142383.
6. Irani RN, Sherman MS. The Pathological Anatomy of Club Foot. JBJS. 1963; 45(1):45–52.
7. Cosma DI, Vasilescu DE. Ponseti treatment for clubfoot in Romania: a 9-year single-centre experience. Journal of Pediatric Orthopaedics B. 2014;23(6):512–6.
8. Morcuende JA, Dolan LA, Dietz FR, Ponseti IV. Radical reduction in the rate of extensive corrective surgery for clubfoot using the Ponseti method. Pediatrics 2004;113:376-80.
9. Lehman WB, Mohaideen A, Madan S, Scher DM, Van Bosse HJ, Iannacone M, et al. A method for the early evaluation of the Ponseti (Iowa) technique for the treatment of idiopathic clubfoot. J Pediatr Orthop. 2003;12(2):133-40.
10. Siapkara A, Duncan R. Congenital talipes equinovarus: a review of current man- agement. J Bone Joint Surg [Br] 2007;89-B:995-1000. Flynn JM, Donohue M,
11. Mackenzie WG. An independent assessment of two club- foot-classification systems. J Pediatr Orthop 1998;18:323-7.
12. Dobbs MB, Rudzki JR, Purcell DB, Walton T, Porter KR, Gurnett CA. Factors predictive of outcome after use of the Ponseti method for the treatment of idiopathic clubfeet. J Bone Joint Surg. 2004;86:22-7. 

13. Morcuende JA, Abbasi D, Dolan LA, Ponseti IV. Results of an accelerated Ponseti protocol for clubfoot. J Pediatr Orthop. 2005; 25(5):623-626. Ponseti IV. Treatment of congenital club foot. JBJS. 1992;74(3):448–54.
14. Xu RJ. A modified Ponseti method for the treatment of idiopathic clubfoot: a preliminary report. Journal of Pediatric Orthopaedics. 2011;31(3):317–9. pmid:21415693.
15. Cooper DM, Dietz FR. Treatment of idiopathic clubfoot. A thirty-year follow-up note. J Bone Joint Surg Am. 1995;77(10):1477–89.
16. Laaveg S, Ponseti IV. Long-term results of treatment of congenital club foot. The Journal of Bone &Joint Surgery. 1980;62(1):23–31.
17. Sana Ullah, Muhammad Inam, Muhammad Arif. Club foot management by accelerated Ponseti technique. http://www.scopemed.org/?mno=170854 15 J Bone Joint Surg Br. 2011; 93(3):404-8.
18. Cowell HR, Wein BK. Genetic aspect of clubfoot. J Bone Joint Surg Am. 1980;62(8):1381–1384.
19. Yamamoto H. A clinical, genetic and epidemiologic study of congenital clubfoot. Jinrui Idengaku Zasshi. 1979;24(1):37–44.
20. Palmer RM. Genetics of talipes equinus varus. J Bone Joint Surg Am. 1964;46:542–556.
21. Elgohary HS, Abulsaad M. Traditional and accelerated Ponseti technique: a comparative study. European Journal of Orthopaedic Surgery & Traumatology. 2015;25(5):949–5
22. Pulak S. Treatment of idiopathic clubfoot by Ponseti technique of manipulation and serial plaster casting and its critical evaluation. Ethiop J Health Sci. 2012, 22.
23. Harnett P, Freeman R, Harrison WJ, Brown LC, Beckles V. An accelerated Ponsetiversus the standard Ponseti method. J Bone Joint Surg [Br] 2011;93- B:404-8
24. Elgohary HS, Abulsaad M. Traditional and accelerated Ponseti technique: a comparative study. European Journal of Orthopaedic Surgery & Traumatology. 2015;25(5):949–53
25. Sætersdal C, Fevang JM, Fosse L, Engesæter LB. Good results with the Ponseti method: a multicenter study of 162 clubfeet followed for 2–5 years. Acta orthopaedica. 2012;83(3):288–93. pmid:22616746

Dr Malik Naseer Ahmad

Resident Orthopaedics, GMC Jammu, India