Determinants of Improvement in Foot Bimalleolar Angle, Pirani Score, and Recurrence in Clubfoot Patients Treated With the Ponseti Technique.

Introduction: Foot bimalleolar angle (FBM angle) and Pirani score are recognized as assessment and prognostic tools for objective assessment of clubfoot (congenital talipes equinovarus, or CTEV) treatment. The present study proposed to study various factors that determine the improvement in FBM angle and Pirani score in patients treated by the Ponseti technique.

Materials And Methods: This prospective observational study was conducted after obtaining ethical clearance, and 42 children with CTEV (60 feet) were enrolled. Various parameters affecting FBM angle and Pirani scoring were recorded for each individual patient on a predesigned proforma. Patients were managed by serial manipulation and casting using the Ponseti technique with weekly follow-ups, and changes in FBM angle and Pirani score were recorded. The result was analyzed, and determinants of improvement in FBM angle, Pirani scoring, and recurrence were compared and reported.

Results: Significant factors affecting FBM angle were age at treatment commencement, severity at presentation, and outside treatment. However, only severity at presentation emerged as the most significant variable. Significant factors affecting Pirani score improvement were age at the start of treatment, severity at presentation, and parent education. However, severity at presentation was the most significant variable. The recurrence of clubfoot was significantly associated with severity at presentation, education of parents, weekly visit compliance, and compliance with orthosis.

Conclusion: The identification of independent risk factors, including various sociodemographic factors affecting CTEV treatment outcomes, can allow clinicians to intervene at various levels of management, including parental counselling and socio-economic support, as measures to enhance compliance and ascertain more promising outcomes.