Modified Ponseti Casting simple and reliable method to improve efficacy of casting in complex clubfoot

The clinical entity of complex clubfoot poses a significant challenge to correction by slippage of casts which further complicates the deformity and prolongs the treatment. A static and dynamic component associated with this deformity causing cast slippage was recognized.

A retrospective study of 17 patients with 25 complex clubfeet over a period of 2 years was conducted by Sourabh Kumar Sinha et al. The study has been published in ‘Indian Journal of Orthopaedics.’ Tug test was used to ascertain the snugness of the cast. To address the dynamic component, distal extent of the cast was limited to metatarsal heads.

The tug test involved stabilizing the knee and thigh with one hand and gently pulling the applied cast with the other hand. The author looked for signs of slippage, such as inward slipping of toes into the cast or complete removal of the cast in case of loosely applied and poorly molded casts. The cast was reapplied if slippage occurred during the tug test. In the absence of slippage, the cast was extended above the knee, with a target knee flexion of 110°.The author used cast padding made by the conventional cotton rolls, as they are less likely to slip against the skin over readymade cast padding.

The key findings of the study were:

• The mean age of patients at diagnosis was 4.41 months (2–7 months).

• The mean pre-casting Pirani score was 4.8 (4–6) and post casting Pirani score was 0.4 (0–1).

• A total of 128 casts were applied to correct 25 complex clubfeet.

• The average number of casts required to achieve correction by the modified Ponseti technique was 5.12 (4–7).

• Overall, four incidences of cast slippage occurred.

The authors concluded that – “The modified Ponseti technique is effective in the correction of complex clubfoot. Tug test can detect casts which are prone to slippage. Limiting the distal extent of the cast to the metatarsal heads can reduce cast slippage by reducing the repeated downward pressure by the toes on the cast.”

Level of evidence: Level 4

Further reading:

The Tug Test and Modified Ponseti Casting: A Simple and Reliable Method to Improve the Efficacy of Casting in Complex Clubfoot

Sourabh Kumar Sinha, Varun Garg et al

Indian Journal of Orthopaedics (2023) 57:1147–1152

https://doi.org/10.1007/s43465-023-00910-w