Application of Ponseti method in patients older than 6 months with congenital talipes equinovarus.
OBJECTIVE
To evaluate the effectiveness of Ponseti method in the treatment of congenital talipes equinovarus (CTE) in children older than 6 months.


METHODS
Ponseti method was used to treat 157 cases (227 feet) of CTE in children older than 6 months. All cases were classified by age and by the degree of deformity severity. The age group classification was: (1) I Group (6 months to 12 months), 113 feet in 81 cases; (2) II Group (1 to 3 years old), 78 feet in 52 cases; (3) III Group (> 3 years old), 36 feet in 24 cases. The degree of deformity of CTE was evaluated with Pirani scoring system. The cases were classified into three groups according to the deformity degree: (1) Mild Group (scoring 1-2.5), 85 feet in 56 cases; (2) Moderate Group (scoring 3-4.5), 104 feet in 71 cases; (3) Severe Group (scoring 5-6), 38 feet in 30 cases. A Pirani score of 0-0.5 is regarded as an excellent result. For each group, we evaluated the number of casts used, the percentage of excellent result according to the Pirani score, and the percentage of percutaneous achillotenotomy. The result was compared among different groups.


RESULTS
The overall percentage of excellent result among all cases was 96.92%. Among the age groups, the percentage of excellence was not statistically different between I Group and II Group (P > 0.05). The percentage of excellence was lower in the III group than the other groups (P > 0.01). Among the groups classified by deformity degree, the percentage of excellence was the lowest in severe group (P < 0.05), and the difference between the mild group and moderate group was not statistically different (P > 0.05). The number of casts used among different groups were different (P < 0.01). Among different groups, the percentages of percutaneous achillotenotomy were significantly different (P < 0.01). 209 feet in 148 cases were followed up for average time duration of 3 years and 11 months. Relapse was observed in 40 feet in 29 cases. The percentages of relapse were not statistically different among different groups (P > 0.05).


CONCLUSIONS
Using Ponseti method to treat CTE for children older than 6 months can achieve excellent results in this study.
Wang
Yan-zhou
YZ
Department of Pediatric Orthopaedics, Provencial Hospital affiliated to Shandong University, Jinan 250021, China. yanzhouwang@gmail.com
Wang
Xiao-wen
XW
Zhang
Peng
P
Wang
Xing-shan
XS
D000125:Achilles Tendon / Q000601:surgery*; D002370:Casts, Surgical; D002675:Child, Preschool; D003025:Clubfoot / Q000601:surgery*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D019637:Orthopedic Procedures / Q000379:methods*; D020127:Recovery of Function; D016896:Treatment Outcome