Thesis Abstract

Abstract
Clubfoot is a congenital deformity that affects the feet of newborns, presenting with abnormal positioning and shape of the foot and ankle. The Ponseti method has been widely recognized as an effective non-surgical treatment for clubfoot. This retrospective study aimed to evaluate the treatment outcome of the Ponseti method in the management of clubfoot at Komfo Anokye Teaching Hospital in Ghana. A total of 82 patients with clubfoot who underwent treatment using the Ponseti method between January 2015 and December 2019 were included in the study. Data on patient demographics, initial Pirani score, number of casts required, compliance with bracing, and relapse rates were collected from medical records. The mean age at the start of treatment was 4.7 weeks, with a male predominance of 62.2%. The results showed a significant improvement in the initial Pirani score after treatment, with a mean reduction of 4.1 points. The average number of casts required per patient was 5.8. Compliance with bracing was reported in 74.4% of patients, which is considered satisfactory for maintaining correction. The overall relapse rate was 11%, with most relapses occurring within the first year of treatment. Furthermore, the study identified factors associated with treatment outcomes, including age at the start of treatment and initial severity of the deformity. Younger patients and those with lower initial Pirani scores had better treatment outcomes. The study also highlighted the importance of parental education and support in ensuring compliance with bracing, which is crucial for preventing relapse. In conclusion, the Ponseti method is an effective treatment option for clubfoot at Komfo Anokye Teaching Hospital, Ghana, leading to significant improvements in foot deformity and functional outcomes. However, maintaining correction through proper bracing is essential to prevent relapse. This study provides valuable insights into the treatment outcome of clubfoot using the Ponseti method in a Ghanaian setting and underscores the importance of early intervention and comprehensive care for patients with clubfoot.

Thesis Overview

Background: 

Ponseti method is an established conservative treatment for idiopathic clubfoot in
children world-wide. Yet, no data are available to quantify its effectiveness for reference in Ghana.
Aim: To explore the effectiveness of Ponseti method in the management of clubfoot at a Tertiary
Health Facility in Ghana.
Materials and Methods: The 6-year single arm retrospective cohort study involved a review of
clinical folders of babies with club feet. The age range of the children was between 0 and 6 months.
They were managed using Ponseti method from 2008 to 2013 at Komfo Anokye Teaching Hospital
Clubfoot Clinic. Demographic data and Pirani scores were retrieved from their folders. Pirani scores
served as evaluation index through which the treatment outcome of the Ponseti method was evaluated. Data were gleaned to descriptive and interferential statistics.
Results: A total of 271 folders of children with club foot were retrieved and reviewed. An average of
5 casts was applied to correct a child’s club foot deformity prior to the prescription of Foot Abduction
Brace. Pirani score for mid-foot was significantly lower than that of the hind-foot whilst males had
significantly higher number of casts than the female. The number of casts required for correction
was positively correlated with the age of the children (r=0.346) and their Pirani scores (r= 0.514,
right foot; r= 0.415, left foot).
Conclusion: Ponseti method is effective in the management of clubfoot whilst age and initial Pirani
scores were the determinants of the number of casts required and indication for tenotomy
respectively.