Differences in Outcomes of Treatment of Idiopathic Clubfoot Using Accelerated Versus Conventional Ponsetti Technique in Children Under Two Years at Kijabe Cure Hospital and Knh

Abstract

Background: Clubfoot is one of the most common congenital deformities, with an incidence of one in 1000 live births worldwide. Management of club foot can be conservative or surgical. Based on Hippocrates’s principles of clubfoot management, there are several conventional methods (Kite method, French method, Ponseti method, which involves manipulation, casting, tenotomy, foot abduction brace, and other physical processes such as kinesiotherapy, thermo-therapy, electro-therapy, splinting, shoe modification and orthotic devices). The Ponseti method results in prolonged latent time to achieving optimal outcomes since the onset of the procedure. This can have increased cost, loss to follow-up and other unfavorable complications of casting. Thus, adopting a method with shorter treatment time would be advantageous to both the hospital and the patient. Broad Objective: To determine the efficacy of ICTEV treatment by comparing Conventional and Accelerated Ponseti technique. Study design and site: Prospective cohort study design conducted in two hospital, KNH and Cure International Hospital. Participants and Methods: Consecutive sampling of children below 24 months (2 years) and undergoing treatment for ICTEV was done. Exposure variable was the accelerated method with control of exposure/non-exposure being the conventional Ponseti method. Outcome variables was time to optimum Pirani score, number of casts changed and complication rates between the two methods. Results: The number of patients enrolled in the study was 25, with a mean age of 5.2 months, male patients (64%) being more than the female patients (36%). Majority of the patients (56%) underwent the conventional ponseti method of treatment. The time taken for the patients treated with accelerated method to achieve optimal Pirani score was significantly shorter (p<0.001) compared to the patients treated with conventional method. Accelerated method of treatment was also associated with fewer complications (25%) compared to the Conventional method (75%). The mean number of casts required in the accelerated method (6.1 ± 1.1) was higher than in the conventional method (5.8 ± 1.2). Lastly, majority of the patients who underwent tendon Achilles tenotomy (84.6%) had been treated with the accelerated method. This number was significantly higher than the patient who were treated with the conventional method (p<0.001). Conclusion/ Recommendation: The accelerated method of treatment was associated with a shorter time to attaining the optimal Pirani score as well as fewer complications compared to the conventional ponseti method. Therefore, the accelerated method may be suitable alternative to the conventional method since it assures a quicker recovery with minimal complications. The accelerated method is associated with higher incidences of Tendon Achilles tenotomy.