A Randomized Controlled Trial to Compare Outcomes of Super - Accelerated and Accelerated Ponseti Casting Technique in the treatment of Idiopathic Clubfoot’’

Abstract

Objective: This study aims to compare the results of super accelerated (1 week) and the accelerated Ponseti techniques (2 weeks) in correcting idiopathic club feet in terms of Pirani scoring at 3 months follow up in foot abduction brace and also to investigate the influence of cast change interval on treatment outcomes as well as to study the demographics of these children.

Study design: A Prospective Randomized Controlled Trial

Place and duration: The study was conducted in Department of Pediatric Orthopedics Children Hospital and Institute of Child Health Faisalabad from July 2021 to December 2021

Methods: Patients recruited were 3 months or younger with follow up in FAO for 3 months. a protocol was designed to compare ‘Super Accelerated Ponseti’ method (Group A) with the ‘Accelerated Ponseti’ method (group B). Group A was treated using ‘Super Accelerated Technique’ in which after 3rd day of first casting sequential three daily castings were performed followed by Tenotomy (total 8 days of casting). In Group B the accelerated technique was used in which four castings were done alternatively followed by tenotomy (total 10 days of casting)

Results: There was no significant difference in Median number of casts to achieve the correction between both groups (p = 0.000435). Group A needed 3 to 20 casts to attain full correction and the median number of casts was 6. Group B needed 2 to 24 casts to attain full correction and median number of casts was 5. In Super Accelerated Group there were no relapses whereas in Accelerated Group there were two cases of residual equinus in which three repeated casts were applied to achieve correction.

Conclusions: Fast casting is safe and equally efficacious in treating idiopathic clubfeet.