title: "The role and ability of orthopaedic postgraduate resident's clubfoot treatment with ponseti's methodology." A comparative study of resident's versus consultant's directed treatment.
abstract: OBJECTIVE
  To evaluate the outcome of Ponseti treatment carried out by the Postgraduate Orthopaedic Trainees compared with the treatment given by their Mentors.
  
  
  METHODS
  The prospective comparative case series study was conducted at Jinnah Postgraduate Medical Centre, Karachi, and comprised idiopathic Congenital Clubfoot Deformity patients treated from September 2012 to December 2013. Also included were a few cases treated between September 2006 and September 2012, who had complete record, serial photograph and updated follow-up. The patients were divided into two groups. Those treated by residents formed Group A and those by consultants were in Group B. The follow-up duration ranged from 06 months to 05 years. Outcome measures included the number of casts required to achieve correction with Pirani score 0.5, the rate of Per-Cutaneous Achilles Tenotomy (PCAT), the rate of early relapse and treatment and failure to maintain correction. SPSS 13 was used for statistical analysis.
  
  
  RESULTS
  Of the 172 patients in the study, 111(64.5%) patients with 185 feet were treated by the residents, while 61(35.5%) patients with 96 feet were treated by consultant. The overall mean age was 25.8±32.88 weeks (range: 1-156 weeks). The difference in age between the two groups was significant (p=0.01). A total of 166(96.51%) patients were on maintenance phase in Foot Abduction Bracing and 6(3.48%) completed the treatment successfully without residual deformity. The median number of cast per patient given by Group A was 6 and 5 in Group B. The number of 8+ casts given in Group A were 46 (24.86%) and 17 (17.7%) in Group B. Tenotomies performed in Group A were 106 (57.27%) and 70 (73%) in Group B, and overall PCAT performed were 183 (65.12%). The overall success rate was nearly similar between the two groups, with the difference of<1%.
  
  
  CONCLUSIONS
  The best practice to achieve excellent to good results from the beginners in Ponseti technique is to provide mentorship training for the skill of Ponseti manipulation, application of cast and continued treatment.
authors.affiliation: HOD, Ponseti Provider,Clubfoot Clinic & Ponseti Training/Research Centre, Department of Orthopaedic Surgery, Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan.
authors.forename: Anisuddin
authors.initials: A
authors.lastname: Bhatti
authors.affiliation: Resident Trainees, Clubfoot Clinic & Ponseti Training/Research Centre, Department of Orthopaedic Surgery, Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan.
authors.forename: Pervez
authors.initials: P
authors.lastname: Ali
authors.affiliation: Resident Trainees, Clubfoot Clinic & Ponseti Training/Research Centre, Department of Orthopaedic Surgery, Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan.
authors.forename: Zeehan
authors.initials: Z
authors.lastname: Naeem
authors.affiliation: Resident Trainees, Clubfoot Clinic & Ponseti Training/Research Centre, Department of Orthopaedic Surgery, Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan.
authors.forename: Javed
authors.initials: J
authors.lastname: Ahmed
authors.affiliation: Resident Trainees, Clubfoot Clinic & Ponseti Training/Research Centre, Department of Orthopaedic Surgery, Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan.
authors.forename: Iftikhar
authors.initials: I
authors.lastname: Memon
authors.affiliation: Senior Registrar, Clubfoot Clinic & Ponseti Training/Research Centre, Department of Orthopaedic Surgery, Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan.
authors.forename: Kashif
authors.initials: K
authors.lastname: Mahmmod
authors.affiliation: Associate Professor, Clubfoot Clinic & Ponseti Training/Research Centre, Department of Orthopaedic Surgery, Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan.
authors.forename: Muhammad Saeed
authors.initials: MS
authors.lastname: Minhas
keywords: Clubfoot, Congenital, Idiopathic, Ponseti, Treatment.