The Treatment Outcomes of Neurogenic and Idiopathic Clubfoot after using Ponseti Technique amongst Clients Enrolled In AIC Cure Hospital, Kiambu, Kenya from 2005 when the clinic began and 2014 after completion of first treatment cycle

Abstract

Treatment of neurogenic clubfoot is challenging due to the high risk of complications such as pressure sores, high cast rate, increased chance of relapse and failure to correct. The Ponseti method, was initially devised for idiopathic clubfoot, but it is increasingly being used for neurogenic clubfoot. The basis of this study was to do a comparative analysis on the treatment outcomes for patients with neurogenic and idiopathic clubfoot using Ponseti technique in order to determine the applicability of this technique in managing the two types of congenital clubfoot in children. In carrying out this study a retrospective study design was adopted. The study site was the clubfoot clinic at AIC Cure International hospital situated in Kiambu County, Kenya. the study examined 218 respondents out of the target population of 740 patients. A systematic random sampling technique was applied where every second file was selected. Data was extracted using a desk review tool and the variables included sociodemographic data and clinical outcomes including Pirani scores, number of casts applied, tenotomy, complications, relapse, need for surgical correction and failure to correct. In addition to the desk review, researcher telephoned the study participants’ parents/guardians to get information on whether participant is pain free, able to wear shoes and whether parent is satisfied with treatment outcomes. The study findings showed that 93% (n=203) of patients had idiopathic whilst 4.8% (n=15) had neurogenic clubfoot. The mean age at 1st assessment was 5 months while most patients were 109 – 120 months (10 years) at time of study. Idiopathic clubfoot participants were casted fewer times than neurogenic. Relapse rate and need for surgery respectively were statistically significant (P= .000 & P=.017) among neurogenic clubfoot participants. Failure of Ponseti occurred in 3 out of 203 idiopathic and 2 out of 15 neurogenic patients. Pain in affected feet/foot was reported in 3 and 51 neurogenic and idiopathic clubfoot participants respectively. Care givers of neurogenic participants expressed less satisfaction with 16.7% being “very dissatisfied”. There is implication that Ponseti has acceptable outcomes in managing idiopathic as well as neurogenic clients although neurogenic clients are at risk of relapse and additional surgery.