# Evaluating the Effectiveness of the Ponseti Technique in Treating Idiopathic Clubfoot: Long-Term Outcomes From an Indian Tertiary Care Centre

## TL;DR

This study confirms the Ponseti method's effectiveness in treating clubfoot in India, emphasizing early treatment and compliance with bracing to avoid surgery.

## Contribution

The study provides long-term evidence of the Ponseti method's success in an Indian context, highlighting the role of early intervention and adherence.

## Key findings

- 94.7% of feet achieved full correction with the Ponseti method.
- Residual deformities occurred in 5.3% of cases, mainly due to poor bracing compliance.
- Early treatment reduced the number of casts needed and improved outcomes.

## Abstract

Introduction: Congenital talipes equinovarus (CTEV) is a common pediatric musculoskeletal deformity, with a male predominance. The Ponseti method, which involves serial casting and bracing, has become the global standard because of its high success rate and reduced need for surgery. This study aimed to evaluate the long-term effectiveness of the Ponseti method in managing idiopathic clubfoot at a tertiary care centre in India.

Materials and methods: This retrospective study analyzed patients with idiopathic clubfoot treated with the Ponseti method at our institute. A total of 331 patients were included, of whom 219 (66%) had bilateral involvement and 112 (34%) had unilateral clubfoot, accounting for 550 affected feet. The inclusion criteria were the absence of prior surgery and the availability of complete records. Treatment included weekly casting, Achilles tenotomy, and bracing with Denis-Browne splints. Outcomes were assessed using Pirani scores.

Results: In our study, 71.29% (n = 236) were males and 28.7% (n = 95) were females. The mean age at presentation was 1.20 months. A total of 94.7% (n = 521) of the feet achieved full correction, with Pirani scores decreasing from 4.36 to 0.43 (p < 0.0001). Tenotomy was required in 77.20% (n = 425) of feet for equinus correction. The average number of casts required for correction was 5.18. Residual deformities were observed in 5.3% (n = 29) of feet. Poor compliance with the bracing protocol was the main reason for these residual deformities in our study.

Conclusion: The Ponseti method remains a highly effective and reliable technique for managing idiopathic clubfoot when applied with adherence to the protocol and adequate caregiver support. Our findings not only reaffirm its global effectiveness but also highlight the importance of early treatment initiation, which reduces the number of casts required and improves outcomes compared with later interventions. The Ponseti technique markedly decreased the need for surgical correction of CTEV in our setting. Sustained bracing and follow-up are critical for preventing relapse. Future research should focus on identifying barriers to brace compliance and evaluating strategies to improve long-term outcomes.