• Mengistu G Mengesha
  • Birhanu Ayana
  • Mengestie M Belay
  • Wubalem Zewde
  • Peter J.


Methods: A five-year retrospective study was conducted. Data analysed with SPSS version 24 and result summarized by texts, tables, and figures. The association between initial Pirani score and number of casts was assessed using the Pearson correlation coefficient with the level of significance set at P<0.05.

Results: A total of 526 patients with mean age at presentation of 15.3 weeks were included. Male account for 387 (73.6%).  More than two-third (70.7%) were born in the health facilities. Nearly half of them (47%) had bilateral involvement followed by right side (27.5%). In average, 5.94 corrective casts were needed to correct the deformity. According to Pearson correlation coefficient, a positive correlation was observed among number of casts to correct the deformity with initial pirani score and age at presentation (r=0.225, p<0.001; r=0.178, p<0.001). Among 587 feet for which tenotomy performed, only 186 tenotomy (31.7%) was done appropriately according to the criteria (HFCS >1 and MFCS = 0).

Conclusions: Ponseti method of club foot treatment is effective in treating idiopathic club foot in our setup. Close monitoring of tenotomy decision based on pirani scoring should be made by consultant orthopedic surgeon in order to prevent unnecessary tenotomy.

Key words:  Idiopathic Clubfoot, Ponseti treatment, Number of casting, Pirani scoring system


Parone V, Testa G, Costarella L, Pavone GS. Congenital idiopathic talipes equinovarus: an evaluation in infants treated by the Ponseti method. Eur Rev Med Pharmacol Sci 2013;17(19):2675–2679.

Ningthoujam Jungindro Singh, Sanjay Keshkar, Pampa De RK. Management of clubfoot by Ponseti technique- our experience. IJPMR 2011;22:12–16.

Malhar N, Kumar CG. Modified Ponseti method of management of neonatal club feet. Acta Orthop Belg 2012;78(2):210–215.

Matthew B Dobbs, Rudzki J R, Derek B Purcell, Tim Walton, Kristina R Porter CAG. Factors Predictive of Outcome after Use of the Ponseti Method for the Treatment of Idiopathic Clubfeet. J Bone Jt Surg 2004;86-A(1):22–27.

Daniel Augusto, Carvalhu Maranho JBV. Congenital clubfoot. Acta Ortop Bras 2011;19(3):163–169.

Mejabi J O, Esan O, Adegbehingbe O, Orimolade E A, Asuquo J, Badmus H D. The Pirani Scoring System is Effective in Assessing Severity and Monitoring Treatment of Clubfeet in Children. Br J Med Med Res 2016;17(4):1–9.

Sharma Gaurav, Balkrushna Mangukiya, Prasad DV, et al. Treatment of Idiopathic Congenital talipes equino varus deformity by Ponseti technique in rural population. Int J Med Res Heal Sci 2013;2(3):363–366.

Omololu B, Ogunlade T. Pattern of congenital orthopedic malformations in an African teaching Hospital. West Afr J Med 2005;24(2):92–95.

Alok Aggarwal, Neha Gupta. The role of the Pirani scoring system in the management of club foot by the Ponseti method. Int J Sci Res 2016;5(6):1284–1287.

Samantha E Parker, Cara T Mai, Matthew J Strickland, et al. Multistate study of the epidemiology of clubfoot. Birth Defects Res Part A - Clin Mol Teratol 2009;85(11):897–904.

Jose A Morcuende, Lori A Dolan, Frederick R Dietz IVP. Radical Reduction in the Rate of Extensive Corrective Surgery for Clubfoot Using the Ponseti Method. Pediatrics 2004;113(2):376–380.

Birhanu Ayana, Peter J Klungsøyr. Good results after Ponseti treatment for neglected congenital clubfoot in Ethiopia. Acta Orthop 2014;85(6):641–645.

Asmare Yitayeh, Berihu Fisseha. Health Condition Associated With Physical Disability Among Children In Ethiopia. Int J Rehabil Sci 2015;04(02):19–24.

Margaret A Honein, Leonard J Paulozzi, Cynthia A Moore. Family history, maternal smoking, and clubfoot: An indication of a gene-environment interaction. Am J Epidemiol 2000;152(7):658–665.

Ning Lu, Li Zhao, Qing Du, Yakun Liu, Florin I. Oprescu JAM. From cutting to casting: impact and initial barriers to the Ponseti method of clubfoot treatment in China. Iowa Orthop J 2010;30:1–6.

Biruk W L. Management of Club foot at Tikur Anbessa Hospital; Addis Ababa, Ethiopia. East Cent African J Surg 2007;12(1):24–29.

Dyer P J, Davis N. The role of the Pirani scoring system in the management of club foot by the Ponseti method. J Bone Jt Surg - Br 2006;88(8):1082–1084.

Anil Agarwal NG. Does initial Pirani score and age influence number of Ponseti casts in children? Int Orthop. 2014;38(3):569–72.

Gray K, Pacey V, Gibbons P, Little D, Frost C BJ. Interventions for congenital talipes equinovarus (clubfoot). Cochrane Database Syst Rev 2012;(4): 1-60.

Ford-Powell VA, Barker S, Khan MSI, Evans AM, Deitz FR. The Bangladesh clubfoot project: The first 5000 feet. J Pediatr Orthop 2013;33(4):40–44.

Porecha M, Parmar D. The Predictive Value of Pirani Scoring System in the Management of Idiopathic Club Foot by Ponseti Method. Internet J Orthop Surg 2008;11(2).

Lynn Staheli. Clubfoot Ponseti Management, 3rd ed. Global HELP Publicatioons, 2009. Pp 1–32.

Joshua Bridgens, Nigel Kiely. Current management of clubfoot (congenital talipes equinovarus). BMJ (Online) 2010; 340: 308–312.

Mazlina Awang, Abdul Razak Sulaiman, Ismail Munajat MEF. Influence of age, weight, and Pirani score on the number of castings in the early phase of clubfoot treatment using Ponseti method. Malaysian J Med Sci 2014;21(2):40–43.

Vaishy AK, Arif M, Acharya D, Choudhary R, Seervi PM, Kumar R. Influence of Beginning Time of Casting for Clubfoot Treatment by Ponseti Method in Different Age Group Infants: A Retrospective Study. Indian J Orthop 2020;54(1):55–9.

Cristina Alves, Carolina Escalde, Pedro Fernandes, Delffin Tavares MC. Ponseti method: Does age at the beginning of treatment make a difference? Clin Orthop Relat Res 2009;467(5):1271–1277.