Outcomes Of the Ponseti Method in Treating Clubfoot and Predictors of Relapse: A Retrospective Study

Abstract

Background: Clubfoot is the most common congenital deformity affecting the foot. Limited data are available in the literature regarding the management of this condition in the Middle East, including Yemen. This study aims to identify the outcomes and predictors of relapse in patients with congenital clubfoot treated with the Ponseti method.

Patients and Methods: A retrospective study was conducted on 102 pediatric patients with congenital clubfoot treated with the Ponseti method at Modern Hospital in Sana'a, Yemen, between 2010 and 2020. Patient demographics, treatment details, and outcomes were collected and analyzed. Univariate and multivariate analyses were used to investigate factors associated with relapse.

Results: The median age was 6.5 months (IQR: 4.0, 9.0), with 83.3% of the patients being under 10 months, and 63 (61.8%) being male. Bilateral clubfoot was found in 55 (53.9%), and 69 (67.6%) of the patients resided in rural areas. Achilles tenotomy was performed in 96 (94.1%) of the cases. With a mean follow-up of 36.0 ± 6.7 months, an average of 9.5 ± 1.6 corrective casts were used. Significant improvements in treatment efficacy were observed, with the initial Pirani score of 4.0 ± 0.6 improving to 1.5 ± 0.2 (P < .001) and the initial Dimeglio score of 12.1 ± 1.7 improving to 4.5 ± 0.7 (P < .001). A total of 15 children (14.7%) experienced a relapse; ten responded to recasting and tenotomy, while three required further treatment, and two underwent additional surgery. In multivariable analysis, the factors significantly associated with relapse were the initial Pirani score (OR: 2.40; 95% CI: 1.43-4.25; p = 0.001) and an increased number of casts (OR: 8.37; 95% CI: 2.89-115.92; p = 0.009).

Conclusion: In this study, the Ponseti method has proven to be an effective intervention for congenital clubfoot in a pediatric population in Yemen, as demonstrated by significant improvements in both the Pirani and Dimeglio scores. Despite these favorable outcomes, the documented relapse rate of 14.7% underscores the necessity for ongoing monitoring and reevaluation of treatment strategies. Notably, factors such as the initial Pirani score and the number of corrective casts were identified as significant predictors of relapse, warranting further investigation in future research.