The Factors of the Failure in the Treatment of Congenital Equinus Clubfoot Varus by the Ponseti Method at the Reference Health Care Center (CSREF) of Commune III of Bamako

Abstract

Clubfoot malformation is the most common serious congenital anomaly af fecting the foot in children. Its treatment by the Ponseti method is simple, prof itable and widely used in the world. Objective : The objective of this study was to identify the factors of the failure of its treatment by the Ponseti me thod. Material and Method: We carried out a retrospective and descriptive study of cases of congenital equinus clubfoot varus at the Reference Health Care Center of Commune III of Bamako over 26 months from September 2020 to November 2022. Data w ere treated with the utmost anonymity. Re sult: This study was performed o n 44 children seen for clubfoot: male (68%) and female (32%), with a sex ratio of 2.1. We obtained 13 cases of recidivism in cluding 7 boys and 6 girls. We found 21 cases of unilateral and 23 bilateral; among which 9 recurrences were found against 4 in the unilateral forms. 85% of recurrences did not have good adherence to the splint and 62% did not come regularly for follow-up consultation. We obtained 33 children with idi opathic clubfeet (75%) with a recurrence of 24%, and 7 children with secondary club feet with 71 % recurrence. There was no recurrence in the postural type . Among the recurrences, 38.5% started treatment between 1 and 6 months, 23.1% from 0 to 1 month and 15.4% at 2 years and more. 85% of recurrences had a Pirani score between 4.5 to 6 at the start of treatment and 15% at a score of 2.5 to 4. Conclusion: The factors of the failure of the Ponseti method are mainl y non-compliance with treatment, secondary clubfeet, and a high Pirani score at the start of treatment.