Long-term clinical and functional outcomes of idiopathic clubfoot patients who were managed with ponseti method at Mulago National Referral Hospital
Abstract
Background: Ponseti method is being used for the management of ICTEV as it has shown consistently good clinical and functional outcomes in both the short and longtime. Relapse is inherent to ICTEV due to the stiff and non-compliant tissue and this is seen to increase with prolonged follow-up period. In the MNRH club foot clinic, many children have been managed by the Ponseti method but due to the lack of a clear follow-up protocol, not much is known about the long-term outcomes of Ponseti on clinical and functional outcomes.
Objectives: To describe long-term outcomes of ICTEV patients who were managed with Ponseti method at MNRH club foot clinic. To determine associated factors which influence the long-term outcome of ICTEV patients.
Methods: This cross-sectional study took place at the MNRH club foot clinic. We gathered socio-demographic and treatment history data using a structured questionnaire. Clinical and functional assessments were performed using PBS and DSI tools. Data was coded, entered into Epidata 4.6, and later analyzed in STATA 14.0. We used means, standard deviations, medians, and interquartile ranges for numerical variables and proportions for categorical data. Bivariate and multivariate analyses were conducted to identify significant factors, with significance considered at p-values < 0.2 and < 0.05, respectively.
Results: 158 patients were enrolled for the study. Of these, 98(62.0%) were male, 00(63.3%) had bilateral involvement, 124 (78.5%) required tenotomy, 23(14.6%) had surgery, 18(11.4%) completed S-FAB phase up to 4 years. Of the 258 feet analyzed, 205 feet (83.3%) had no/slight deformity and 82.9% had good functional outcome. Noncompliance with S-FAB increased the likelihood of developing a recurrence by 4.6 times. Patients who did not undergo surgery were 0.46 times less likely to develop deformity.
Conclusion: The long-term outcomes of ICTEV patients who were managed with Ponseti method at MNRH club foot clinic were excellent/good and similar to those in literature. Failure to adhere to bracing and surgery were found to predict outcome.
Clubfoot awareness and sensitization should be done to enable Ponseti treatment to start early. Patients should be encouraged to complete the 4 years S- FAB casting phase.
Ponseti method is being used for the management of ICTEV as it has shown consistently good clinical and functional outcomes in both the short and longtime. Relapse is inherent to ICTEV due to the stiff and non-compliant tissue and this is seen to increase with prolonged follow-up period. In the MNRH club foot clinic, many children have been managed by the Ponseti method but due to the lack of a clear follow-up protocol, not much is known about the long-term outcomes of Ponseti on clinical and functional outcomes.
Objectives: To describe long-term outcomes of ICTEV patients who were managed with Ponseti method at MNRH club foot clinic. To determine associated factors which influence the long-term outcome of ICTEV patients.
Methods: This cross-sectional study took place at the MNRH club foot clinic. We gathered socio-demographic and treatment history data using a structured questionnaire. Clinical and functional assessments were performed using PBS and DSI tools. Data was coded, entered into Epidata 4.6, and later analyzed in STATA 14.0. We used means, standard deviations, medians, and interquartile ranges for numerical variables and proportions for categorical data. Bivariate and multivariate analyses were conducted to identify significant factors, with significance considered at p-values < 0.2 and < 0.05, respectively.
Results: 158 patients were enrolled for the study. Of these, 98(62.0%) were male, 00(63.3%) had bilateral involvement, 124 (78.5%) required tenotomy, 23(14.6%) had surgery, 18(11.4%) completed S-FAB phase up to 4 years. Of the 258 feet analyzed, 205 feet (83.3%) had no/slight deformity and 82.9% had good functional outcome. Noncompliance with S-FAB increased the likelihood of developing a recurrence by 4.6 times. Patients who did not undergo surgery were 0.46 times less likely to develop deformity.
Conclusion: The long-term outcomes of ICTEV patients who were managed with Ponseti method at MNRH club foot clinic were excellent/good and similar to those in literature. Failure to adhere to bracing and surgery were found to predict outcome.
Clubfoot awareness and sensitization should be done to enable Ponseti treatment to start early. Patients should be encouraged to complete the 4 years S- FAB casting phase.