Bandoh, A.K.Addo, A.O.Segbefia, M.2018-12-212018-12-2120139789988860288; 9789988860226pp. 194-206http://ugspace.ug.edu.gh/handle/123456789/26631In lieu of an abstract, here is a brief excerpt of the content: •194• Chapter 16 Outcome of Treatment of Clubfoot at the Korle Bu Orthopaedic Unit Using the Ponseti Method Bandoh, A. K, Addo, A. O, Segbefia, M. Introduction Clubfoot is a complex developmental deformation of the foot and the genes responsible for the deformity has been reported to be active from the 12th to the 20th week of foetal life and can last until three to five years of age. 1 The deformity has four components; equinus at the ankle, varus at the hindfoot, forefoot adductus and cavus. The goal of treatment is to attain a functional, pain-free, plantigrade foot with good mobility. In the developing world, many of the cases are untreated or poorly treated, leading to a neglected clubfoot. These children undergo extensive corrective surgery later, often with disturbing failures and complications.The foot after surgery looks better, but is stiff, weak and often painful. Clubfoot in an otherwise normal child can be corrected in two months or less with the Ponseti method of manipulations and plaster cast application with minimal or no surgery. The Ponseti method of correction of clubfoot deformity requires serial corrective casts with long-term brace maintainance of correction. Treatment needs to be started as soon as possible and should be followed under close supervision. 2 Brace should be worn full-time (day and night) for the first three months after the tenotomy cast is removed, then for 12 hours at night and 2 to 4 hours in the middle of the day, for a total of 14-16 hours (night and naps protocol) during each 24-hour period. In the brace, the knees are left free. Bracing is continued for up to four years of age and the outcomes are good. Morcuende et al.3 reported a 6 percent •195• Outcome of Treatment of Clubfoot at the Korle Bu Orthopaedic Unit Using the Ponseti Method relapse rate in compliant patients and 80 percent in non-compliant patients. This method is suited for developing countries with scarce resources and can be learnt by allied health professionals very easily.4 The outcomes can be evaluated using the Pirani score which is easy to use with a good interobserver and intraobserver reliability5 Considering that about 100,000 babies are born worldwide each year, with 80 percent with clubfoot occurring in developing nations,4 it is important for many more people to learn the Ponseti method. If the clubfoot is not treated, it leads to severe disability where shoe wearing and mobilization are greatly impaired. The deformity associated with the neglected clubfoot is not acceptable and the children often end up receiving extensive surgical procedures resulting in a chronically painful foot. The current method of early treatment in Ghana is the Ponseti method. Even though the method has been in use for some time, to date,thereisnopublishedworkonitseffectivenesstoprovideevidencebased prognostic outcome that can inform clinical management of cases. This also makes it difficult to advisee parents and relations on how many casts are required to correct the clubfoot deformity based on the Pirani score This study provides baseline data on the condition to enable clinicians to manage clubfoot cases adequately and non-operatively and give advice to parents and/or relations on the prognosis of the deformity. Literature Review Clubfoot is the commonest congenital deformity in babies. More than 100,000 babies are born worldwide each year with congenital clubfoot. Around 80 percent of the cases occur in developing nations.4 The male-to-female ratio is high at 3:1.5 Palmer6 explained this by suggesting that females require a greater number of predisposing factors than males to produce a clubfoot deformity. Social bias and increased attention towards males in our region can account for the higher incidence in males. The order of birth also seems to have an influence on the occurrence of clubfoot, with 65percent of cases in •196• Chapter 16 first-born children, which is in accordance with various studies.7 There is no relationship of clubfoot to the type of birth.4 Many different clubfoot classification systems have been proposed but no single one is universally accepted. At a minimum, a useful classification should distinguish postural, self-resolving clubfoot from true clubfoot which requires orthopaedic treatment. A more advanced classification could discern subtypes of nonsyndromic clubfeet such as complex idiopathic or neurogenic-type clubfeet.8 An ideal classi- fication would accurately portray the initial severity of the deformity and have prognostic ability.9 The Pirani score is easy...entreatmentclubfoottreatment of clubfootorthopaedic uniPonseti methodBook chapter