Early results of accelerated versus conventional ponseti method in the treatment of idiopathic clubfoot as seen in Mulago Hospital, Kampala, a case control study.

Abstract

INTRODUCTION: In Uganda, over 1,600 children with idiopathic clubfoot are born annually. Conventional ponseti method has demonstrated a 76% correction rate with 17% loss to follow up in Kampala, Uganda. Accelerate ponseti method with manipulation and casting every 5 days has been found to be safe and greatly decreases treatment time. OBJECTIVE: The aim of this study was to compare the correction rates of accelerated ponseti method versus the conventional ponseti method in the treatment of idiopathic club foot among patients in Mulago Hospital, Kampala. METHODS: This was a case-control study with historical controls done between February and November 2006, thereafter accelerated ponseti method from November 2006 through march 2007. All children that presented with idiopathic clubfoot were recruited for accelerated ponseti method. Cases were followed up until full correction of midfoot was RESULTS: By the end of the study 36 cases and 64 controls were recruited into the study of which 85.0% were children between birth and two months, majority being males (70.0%). In 48.5% of the children, there was bilateral involvement of both feet with an equal proportion of the right and left foot affected. Most of the children (70.0%) were residents of Kampala city. The cases had an average correction of 16.32 days {SD 8.5} while the controls had 34.64 days {SD 20.9} and the difference was statistically significant {85% CI -23.11, -13.63, P= 0.000}. Survival analysis showed that, the survival distribution of the cases and controls were statistically significant (Log Rank 53.39; p= 0.000). CONCLUSION Accelerated ponseti method has similar early treatment outcomes in the management of idiopathic clubfoot as conventional ponseti method, and yet it had no drop outs, with minor complications.