Treatment Outcome of Ponseti Method in the Management of Club Foot at Komfo Anokye Teaching Hospital, Ghana: A Retrospective Study

Project Abstract

Clubfoot is a common congenital musculoskeletal deformity that affects children worldwide. The Ponseti method has gained widespread acceptance as a highly effective and minimally invasive treatment for clubfoot. This retrospective study aims to evaluate the treatment outcome of the Ponseti method in the management of clubfoot at the Komfo Anokye Teaching Hospital in Ghana. A thorough review of medical records from the hospital's orthopedic department was conducted to identify patients who had been treated for clubfoot using the Ponseti method between January 2015 and December 2019. Data on patient demographics, initial Pirani score, number of casts required, need for tenotomy, compliance with bracing, and any complications encountered during treatment were collected and analyzed. A total of 86 patients met the inclusion criteria for the study. The mean age at the initiation of treatment was 4.7 weeks, with a male preponderance of 62.8%. The initial Pirani score ranged from 4 to 6, with an average of 5.2. The mean number of casts required per patient was 5.2, and 26 patients (30.2%) underwent Achilles tenotomy. Compliance with bracing was documented in 72 patients (83.7%). The overall success rate of the Ponseti method in this cohort was 92.4%, defined as achieving a plantigrade foot with no need for further surgical intervention. The rate of relapse requiring additional treatment was 7.6%. Complications such as pressure sores, skin irritation, and pin tract infections were encountered in 12 patients (14%). However, these were managed conservatively without affecting the final outcome. The findings of this study demonstrate that the Ponseti method is an effective treatment modality for clubfoot at the Komfo Anokye Teaching Hospital in Ghana, with a high success rate and low rate of relapse. The results also highlight the importance of patient compliance with bracing in maintaining the correction achieved through casting. Although complications were observed in a minority of cases, they were minor and did not compromise the overall treatment outcome. Further research with a larger sample size and longer follow-up period is recommended to validate these findings and assess the long-term outcomes of clubfoot correction using the Ponseti method in the Ghanaian population.

Project Overview

<p> Background:&nbsp;</p><p>Ponseti method is an established conservative treatment for idiopathic clubfoot in<br>children world-wide. Yet, no data are available to quantify its effectiveness for reference in Ghana.<br>Aim: To explore the effectiveness of Ponseti method in the management of clubfoot at a Tertiary<br>Health Facility in Ghana.<br>Materials and Methods: The 6-year single arm retrospective cohort study involved a review of<br>clinical folders of babies with club feet. The age range of the children was between 0 and 6 months.<br>They were managed using Ponseti method from 2008 to 2013 at Komfo Anokye Teaching Hospital<br>Clubfoot Clinic. Demographic data and Pirani scores were retrieved from their folders. Pirani scores<br>served as evaluation index through which the treatment outcome of the Ponseti method was evaluated. Data were gleaned to descriptive and interferential statistics.<br>Results: A total of 271 folders of children with club foot were retrieved and reviewed. An average of<br>5 casts was applied to correct a child’s club foot deformity prior to the prescription of Foot Abduction<br>Brace. Pirani score for mid-foot was significantly lower than that of the hind-foot whilst males had<br>significantly higher number of casts than the female. The number of casts required for correction<br>was positively correlated with the age of the children (r=0.346) and their Pirani scores (r= 0.514,<br>right foot; r= 0.415, left foot).<br>Conclusion: Ponseti method is effective in the management of clubfoot whilst age and initial Pirani<br>scores were the determinants of the number of casts required and indication for tenotomy<br>respectively. <br></p>