Result of Neglected Idiopathic Clubfoot Treatment by Ponseti Technique: A Case Study from Zero Clubfoot Project in Bangladesh

Congenital idiopathic clubfoot is the most common crippling deformity of ankle and foot which is a complex deformity consisting of four components: cavus, adductus, varus & equinus. Untreated clubfoot after 03 years of age is termed as neglected clubfoot. Prevalence of this type of clubfoot is high in developing countries due to lack of appropriate treatment at appropriate age. Established treatment option is open surgical posteromedial release which often leads to scarring and stiffening of the ankle and foot, resulting in limitation of motion and strength. However, several orthopedic surgeons around the world reported that neglected clubfoot children of around 13 years can also be treated by the Ponseti technique which initially introduced by Lourenco AF, Morcuende JA and also supported by Khan and Kumar. A case study method was used to present this case of Mr. Alam, a 24 years old university student with bilateral neglected clubfoot, treated at LMRF Healthcare center in Chittagong, Bangladesh. During 1st assessment of this case four typical features were found and assessed by Pirani score which is standard & validated clubfoot deformity measuring technique. Before treatment the total Pirani score was 4.5. The planned treatments were: manipulation, serial casting, tenotomy and follow-up with Ankle Foot Orthosis (AFO). Initial 8 serial casts, bilateral percutaneous achilles tenotomies and recasted twice in a period of 3 months to get desired plantigrade position. Follow-ups were done in every two weeks but feet position and functional abilities did not improve as expected. After 4 months of 1st tenotomy, another surgery performed in combination of tenotomy, fasciotomy & tibialis anterior tendon transfer at both feet. After removing cast after 2 weeks AFO was given along with physiotherapy. All four typical presentation was corrected with little adduction. The outcome measure was done using Pirani score which is 1.0 and functional status which are minimal scaring, pain free & mobilizing feet, walking normally with show, bi-cycling on plantigrade foot. The objective of this case study is to provide evidence for treating neglected adult clubfeet by Ponseti technique.

KEYWORDS: Neglected clubfoot, Ponseti Technique, Zero Clubfoot, Bangladesh