Retrospective Comparative Analysis of Ponseti Method of Treatment for Idiopathic and Nonidiopathic Clubfoot: A 4 year follow-up study.

INTRODUCTION: This study sought to critically evaluate the effectiveness of the Ponseti method in treating idiopathic and non-idiopathic clubfoot, and compared clinical outcomes over a 4-year follow-up. MATERIALS AND METHODS: A total of 75 children (105 clubfeet) were treated with the Ponseti casting protocol at an institution-based clubfoot clinic. Group I comprised 45 patients (63 clubfeet) with idiopathic clubfoot, while Group II included 30 patients (42 clubfeet) with non-idiopathic clubfoot, including arthrogryposis multiplex congenita, flail myelomeningocele, spina bifida, and various syndromic clubfoot. Demographic characteristics, number of casts, tenotomy rate, recurrence, need for minimally invasive adjunct procedures in recurrent or residual cases, and treatment success were compared. Clinical outcomes were assessed using the Pirani score at each follow-up, while brace compliance was based on subjective parent-reported adherence at brace initiation and treatment completion. RESULTS: Group I required significantly fewer casts than Group II (median 5.0 vs. 8.0; P < 0.001), whereas tenotomy rates were comparable (75.5% vs. 73.3%). Multivariable linear regression identified higher initial Pirani score, older age at presentation, rigid non-idiopathic foot type, and recurrent presentation as independent predictors of increased casting requirements. The flail subtype did not differ significantly from idiopathic clubfoot in casting burden. Recurrence was significantly lower in Group I (5/63 [7.9%]) than in Group II (9/42 [21.4%]; P = 0.042). A significant Spearman correlation between initial Pirani score and casting requirement was observed only in the flail subgroup (P = 0.007) of Group II. At final follow-up, treatment success (Pirani score ≤0.5) was achieved in 98.82% of Group I and 95.41% of Group II, P < 0.001. CONCLUSION: The Ponseti method is an effective and reliable treatment for both idiopathic and non-idiopathic clubfoot. In recurrent cases, timely minimally invasive adjunctive procedures may restore correction and reduce the need for extensive surgical release at later stages.