Mid-term clinical and radiological outcomes in children with Idiopathic Congenital Talipes Equinovarus (ICTEV) managed by the ponseti technique at Mulago Hospital - Uganda.

Abstract

Background: Idiopathic congenital talipes equino varus (ICTEV) is a complex three-dimensional deformity of the foot consisting of four components; equinus, varus, adductus and cavus deformities. Worldwide 150,000-200,000 babies with clubfoot are born each year with the incidence of 0.39-7/1000 live births. In Uganda the incidence stands at 1.2/1000 live births and according to the study conducted at Mulago Hospital in 2005 by Ayella, he reported the incidence of 2.47/1000 live births with a male to female ratio of 1.4:1. Ponseti method of treatment of ICETV has been the method of choice in the past 7 decades since 1950. Excellent outcomes of treatment have been reported in up to 98% of the feet at the midterm evaluation in other countries and this method was adapted in Uganda about 9 years ago. There is paucity of information on the midterm outcomes of patients treated with Ponseti method in Uganda. Study objectives: This study aimed at determining the midterm clinical and radiological outcomes of patients with ICTEV managed by the Ponseti method at Mulago Hospital clubfoot clinic in the period of 2006-2009. Methods: This was a cross sectional study conducted in Mulago Hospital in the months of November and December 2013, where 68 feet in 45 patients treated by Ponseti technique were studied. A questionnaire and PBS Score clinical assessment tool were used to obtain information on the patients’ socio- demographics, clinical, functional and radiological treatment outcomes. Results: A total of 68 feet in 45 patients were studied, 29 (64.4%) were males and 16 (35.6%) were females, with a male to female ratio of 1.8: 1. The mean age of the patients was 73.22 months (SD 11.364, range 48-96 months). 39 patients (86.7%) presented early for treatment while 6 (13.3%) presented late. In the assessment of the 68 feet treated with the Ponseti method for ICTEV, 46 feet (68%) had good to excellent treatment outcomes while 22 feet (32%) had a relapse of moderate and severe deformity. Good functionality of the feet was reported with 61.8% having had no pain in the affected foot and 69% and 55.9% reported to have no limitation in their ability to walk or run respectively. Radiological correction was observed in 88.4% of the feet that had completed treatment. Conclusion: The Ponseti method is an effective method of treatment of ICETV with good to excellent outcomes in the midterm in low resource setting like Uganda. Recommendations: Strategies to increase on community awareness and sensitization about clubfoot deformity and its complications should be taken up by the Ministry of Health Uganda and consider clubfoot in the context of public health. When patients complete the four year treatment protocol and are discharged from the clinic, further follow up is required to be able to detect the late onset relapses and therefore offer them treatment as early as possible. A similar study should be done to determine the treatment outcomes both in the midterm and long term.