Abstract
Traditionally clubfoot in South Africa is treated by manipulation, serial casting and, at the age of 3 to 4 months, posteromedial release. Revision surgery, with its attendant problems, is often necessary.
In November 2003 we started using the Ponseti technique. To date we have treated 61 feet, most of which are type-III according to the Harold and Walker classification. Serial castings are done according to Ponseti technique. Initially the forefoot is manipulated into supination to align it with the hindfoot. The talonavicular joint is gradually reduced until 75° of abduction is achieved. Then percutaneous tenotomy is done to correct hindfoot equinus. Manipulation is done weekly and an above-knee cast is applied. Following tenotomy, the cast remains in place for 3 weeks, after which a Denis Brown splint is worn continually (except at bath time) for 3 months and then at night for 3 years. Parent compliance has been good.
We have had six failures to date. One foot was found to have tarsal coalition and another was an arthrogrypotic foot, which was successfully corrected.
Our results suggest that most operations for clubfoot are avoidable. The Ponseti manipulation technique is simple and can easily be taught to the staff of peripheral hospitals, making it ideal for treatment of clubfoot in Africa.
Secretary: Dr H.J.S. Colyn, Editor: Professor M.B.E. Sweet. Correspondence should be addressed to SAOA, Box 47363, Parklands, Johannesburg, 2121, South Africa.
