A Survey of Factors Associated With Idiopathic Clubfoot Relapse After Ponseti Treatment

Abstract

Worldwide, Congenital Talipes Equinovarus (CTEV) is a common foot deformity encountered in the pediatric population with an incidence of 1 in every 1000 births. This problem is more common in low-middle income countries. In Africa, the prevalence of CTEV is 2/1000live births (Uganda).At the Kenyatta National Hospital (KNH) in Kenya, an average of 260 children are diagnosed with CTEV annually. While a lot of effort has been made to treat CTEV, success rates are not always 100% and about 25% of operated clubfeet will develop recurrence or show a marked residual deformity. Between 3% - 5% rates of recurrence of clubfoot after Ponseti treatment have been reported across the world. Studies have attributed CTEV relapse after Ponseti manipulation to poor adherence to treatment regime and improper use of foot braces. At KNH Treatment for CTEV is both operative and non-operative. The gold standard for non-operative treatment is Ponseti manipulation. There is need to study relapse after Ponseti manipulation to determine risk factors and identify corrective measures especially in low resource settings like Kenya. Objective: To determine the factors associated with clubfoot recurrence after Ponseti treatment. Design: Case-Control study. Setting: Foot clinic at KNH and the outpatient clinic at Kijabe AIC Cure Hospital. Patient and methods: Patients diagnosed with idiopathic CTEV and had used the Foot Abduction Brace (FAB) for at least one year were recruited. Sample size was 24 cases and 70 controls. Data on socio-demographic characteristics, duration of treatment, compliance in use of brace, presence of CTEV relapse, type of CTEV relapse and mitigating efforts employed by care providers to contain the relapse. The following parameters were used to determine the presence of CTEV relapse; Pirani score, foot bisector, thigh foot angle and foot progression angle. xiv Absence of relapse was defined as having a Pirani score of 0 and foot bisector passing through second toe. The frequency of flexibility/stiffness of ankle joint, presence of callosities, gait characteristics (toe walking, side stepping), and parental/guardian satisfaction, was tabulated. The study was carried out over a six week period through the months of December 2016 and April 2017. Relapse factors were compared and analyzed in terms of socio-demographic characteristics, history of treatment for clubfoot, duration of treatment for clubfoot and the outcome measures. Data collection through structured questionnaires was analyzed using IBM statistics (SPSS) version 21. Results are presented using tables, textual write up, charts and graphs.