The Analysis Of Effectiveness Of Congenital Talipes Equinovarus Treated By Ponseti Method

Objective:To analyze the effectiveness of Ponseti method applied to congenital talipes equinovarus(CTEV)and compare whether there is a difference in the X-ray index between treated clubfeet and healthy feetMethods:A retrospective study was conducted for children with CTEV treated by Ponseti method in our hospital from October 2014 to March 2018.Pirani score was used for evaluation during follow-up.X-ray images were taken on standing anteroposterior projection,standing lateral projection,standing long-axial projection of calcaneus and lateral projection of maximal dorsiflexion.Talo-first metatarsal angle and talocalcaneal angle on anteroposterior projection,talo-first metatarsal angle and calcaneal pitch angle on lateral projection,tibiocalcaneal angle and talocalcaneal angle in maximal dorsifl exion on lateral projection,the varus angle of calcaneus on standing long-axial projection of calcaneus were measured.T-test or Wilcoxon signed rank test was used to analyze the parameters.Compare and analyze the talo-first metatarsal angle and calcaneal pitch angle on lateral projection between 10 bilateral cases(20 feet)and healthy control group(10 children,20 feet)whose gender and age were matched during the same period.Results:29 unilateral CTEV children,consisting of 9 on the left and 20 on the right and 10 bilateral CTEV children were included.39 children,49 clubfeet in total were evaluated.There were 31 boys and 8 girls.The ages of patients were 4-59 months(26.8 months on average)at follow-up,2-120 days(25.9 days on average)at treatment initiation.Follow-up duration was 2-56 months(31.8 months on average).4 feet didn’t do percutaneous Achilles tenotomy(PAT),3-5 times of plaster fixation once a week(3.5 times on average)were performed.PAT was performed in 45 feet.Plaster fixation was performed once one week before surgery for 3-10 times(4.7 times on average)and 2-5 weeks after surgery(3.1 weeks on average).Pirani score was 0-1(0.14 on average),of which 9 feet got 0.5,1 foot got 1 and 39 feet got 0.All clubfeet could achieve painless and functional feet.On anteroposterior projection of the unilateral cases,the talo-first metatarsal angle measured on the affected side and healthy side were 13.07°、19.97°(P=0.001);and the talocalcaneal angle were 32.97°、41.79°(P=0.000).On lateral projection of the unilateral cases,the talo-first metatarsal angle measured on the affected side and healthy side were 13.07°、19.97°(P=0.001);and the calcaneal pitch angle were 32.97°、41.79°(P=0.000).On lateral projection of maximal dorsiflexion of the unilateral cases,the tibiocalcaneal angle measured on the affected side and healthy side were 57°、40.14°(P=0.000),and the talocalcaneal angle were 32.14°、49.93°(P=0.000).On standing long-axial projection of calcaneus of the unilateral cases,the varus angle of calcaneus measured on the affected side and healthy side were-8.93°、-5.45°(P=0.006).The difference between the affected side and the healthy side was statistically significant(P<0.05).The mean value of the talo-first metatarsal angle on lateral projection of bilateral cases and healthy control group were 8.60°、18.15°(P=0.001);and the calcaneal pitch angle were 6.45°、13.40°(P=0.016).The difference were statistically significant(P<0.05)Conclusion:In the short term after treatment with Ponseti method of CTEV children,all clubfeet had a good recovery in the aspect of appearance and function,but the radiographic parameters showed significant differences.