Early Experience with Ponseti Club Foot Management in Lagos, Nigeria

Background: The first Ponseti clubfoot management workshop in Nigeria was held in Ile-Ife in December 2009, facilitated by a team from the University of Iowa. Prior to this, very few Nigerian orthopaedic surgeons had been trained to use this technique. The objective of this study was to evaluate the initial experience and outcome of treatment of idiopathic clubfoot using the Ponseti method in our teaching hospital club foot clinic.
Methods: A prospective study of congenital club feet managed in our clubfoot clinic from January 2010 to December 2011 using the Ponseti method. Biographic data, severity using Pirani score, duration of treatment and outcome were evaluated. Cases with less than one year follow-up and syndromic clubfeet were excluded.
Results: A total of 106 patients (158 feet, 54 unilateral and 52 bilateral) were treated. Age ranged from 7 days to 4 years, and there were 40 females and 66 males. Pirani score at presentation was 4 and less in fifty feet (31.6%) and above 4 in 108 (68.4%). Percutaneous achilles tenotomy was performed on 42 feet (26.6%). Initial correction was achieved in 152 feet (96.2%). Mean number of casts to correction was 4.6. Relapse was observed in 8 feet (5.16%) within one year. The foot abduction brace was used as prescribed in 60 patients (56.8%)
Conclusion: Initial observations indicate the outcome of clubfoot management using the Ponseti method is encouraging. Few casts are required, treatment duration is short and complications are minimal. Brace compliance was a challenge