title: Results of clubfoot treatment after manipulation and casting using the Ponseti method: experience in Harare, Zimbabwe.
abstract: OBJECTIVE
  The objective of this study was to evaluate the outcomes of the Ponseti manipulation and casting method for clubfoot in a tertiary hospital in Zimbabwe and explore predictors of these outcomes.
  
  
  METHODS
  A cohort study included children with idiopathic clubfoot managed from 2011 to 2013 at Parirenyatwa Hospital. Demographic data, clinical features and treatment outcomes were extracted from clinic records. The primary outcome measure was the final Pirani score (clubfoot severity measure) after manipulation and casting. Secondary outcomes included change in Pirani score (pre-treatment to end of casting), number of casts for correction, proportion receiving tenotomy and proportion lost to follow up.
  
  
  RESULTS
  A total of 218 children (337 feet) were eligible for inclusion. The median age at treatment was 8 months; 173 children (268 feet) completed casting treatment within the study period. The mean length of time for corrective treatment was 10.2 weeks (9.5-10.9 weeks). Of the 45 children who did not complete treatment, 28 were under treatment and 17 were lost to follow up. A Pirani score of 1 or less was achieved in 85% of feet. Mean Pirani score at presentation was 3.80 (SD 1.15) and post-treatment 0.80 (SD 0.56, P-value <0.0001). Severity of deformity and being male were associated with a higher (worse) final Pirani score. Severity and age over two were associated with an increase in the number of casts required to correct deformity.
  
  
  CONCLUSIONS
  This case series demonstrates that the majority (80%+) of children with clubfoot can achieve a good outcome with the Ponseti manipulation and casting method.
authors.affiliation: International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK. tracey.smythe@lshtm.ac.uk.
authors.forename: Tracey
authors.initials: T
authors.lastname: Smythe
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Chandramohan
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Bruce
authors.affiliation: International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Hannah
authors.initials: H
authors.lastname: Kuper
authors.affiliation: Oxford NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Headington, UK.
authors.forename: Christopher
authors.initials: C
authors.lastname: Lavy
authors.affiliation: International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Allen
authors.initials: A
authors.lastname: Foster
mesh_terms: D002370:Casts, Surgical; D003025:Clubfoot / Q000628:therapy*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015915:Motion Therapy, Continuous Passive / Q000379:methods; D019637:Orthopedic Procedures / Q000379:methods; D016896:Treatment Outcome; D015030:Zimbabwe
keywords: Ponseti; Traitement; Tratamiento; Zimbabue; Zimbabwe; analyse de cohorte; análisis de cohortes; clubfoot; cohort analysis; congenital talipes equinovarus; pie equinovaro; pied bot; talipes equinovarus congénito; treatment; varus équin congénital