title: Evaluation of Ponseti method in neglected clubfoot.
abstract: BACKGROUND
  Gentle passive manipulation and casting by the Ponseti method have become the preferred method of treatment of clubfoot presenting at an early age. However, very few studies are available in literature on the use of Ponseti method in older children. We conducted this study to find the efficacy of Ponseti method in treating neglected clubfoot, which is a major disabler of children in developing countries.
  
  
  METHODS
  41 clubfeet in 30 patients, presenting after the walking age were evaluated to determine whether the Ponseti method is effective in treating neglected clubfoot. This is a prospective study. Pirani and Dimeglio scoring were done for all the feet before each casting to monitor the correction of deformity. Quantitative variables were expressed as mean ± standard deviation and compared between preoperative and postoperative followup using the pairedt-test. Also, the relation between the Pirani and Dimeglio score, and age at presentation with the number of casts required was evaluated using Pearson's correlation coefficient. No improvement in Dimeglio or Ponseti score after 3 successive cast was regarded as failure of conservative management in our study.
  
  
  RESULTS
  The mean age at presentation was 3.02 years (range 1.1 - 10.3 years). The mean followup was 2.6 years (range 2-3.9 years). The mean number of casts applied to achieve final correction were 12.8 casts (range 8 - 18 casts). The mean time of immobilization in cast was 3.6 months. The mean Dimeglio score before treatment was 15.9 and after treatment were 2.07. The mean Pirani score was 5.41 before treatment and 0.12 after treatment. All feet (100%) achieved painless plantigrade feet without any extensive soft tissue surgery. 7 feet (17%) recurred in our average followup of 2.6 years.
  
  
  CONCLUSIONS
  Painless, supple, plantigrade, and cosmetically acceptable feet were achieved in neglected clubfeet without any extensive surgery. A fair trial of conservative Ponseti method should be tried before resorting to extensive soft tissue procedure.
authors.affiliation: Department of Orthopaedics, Lady Hardinge Medical College, New Delhi, India.
authors.forename: Abhinav
authors.initials: A
authors.lastname: Sinha
authors.affiliation: Department of Orthopaedics, Lady Hardinge Medical College, New Delhi, India.
authors.forename: Anil
authors.initials: A
authors.lastname: Mehtani
authors.affiliation: Department of Orthopaedics, Lady Hardinge Medical College, New Delhi, India.
authors.forename: Alok
authors.initials: A
authors.lastname: Sud
authors.affiliation: Department of Orthopaedics, Lady Hardinge Medical College, New Delhi, India.
authors.forename: Vipul
authors.initials: V
authors.lastname: Vijay
authors.affiliation: Department of Orthopaedics, Lady Hardinge Medical College, New Delhi, India.
authors.forename: Nishikant
authors.initials: N
authors.lastname: Kumar
authors.affiliation: Department of Orthopaedics, Lady Hardinge Medical College, New Delhi, India.
authors.forename: Jatin
authors.initials: J
authors.lastname: Prakash
keywords: Clubfoot; Dimeglio scoring; Pirani scoring; Ponseti; foot deformities; neglected clubfeet; neglected diseases; plaster correction; plaster of paris; prospective studies