Factors Associated with the Number of Casts in the Management of CTEV by Using the Ponseti Method :A Retrospective, Analytical Study

Jefry Sondang, Chaeruddin Rasjad, Arifin Seweng, Prihantono Prihantono


The Ponseti method is an effective technique for treating Congenital Talipes Equinovarus (CTEV), which involves serial casting to correct the deformity. We investigated the correlation of the number of casts with patient’s age at presentation, initial Pirani score and Dimeglio score. This was an analytic retrospective study of CTEV patients treated with the Ponseti method in Dr. Wahidin Sudirohusodo Hospital from January 2011 to December 2018. Variables of initial Pirani score, Dimeglio score, age at presentation, and the number of casts to achieve correction were collected from the patient’s medical record. The data obtained were subjected to statistical analysis using ANOVA test and Spearman correlation test.  There were 90 patients included in this study. Male (64 % ) are more common than female. Patients with bilateral foot disorders are more often than unilateral. The most common age at the first presentation is under the age of 1 month. Most patients require four circular casts. The initial average of Pirani score is 0.7 and the initial average of Dimiglio score is 13.0. Analysis of each variable with ANOVA test showed that age had a significant relationship (p <0.001), Pirani score (r = +0.885), and Dimeglio score (r = +0.76) had a significant positive correlation with the number of circular cast.The number of circular casts needed to correct CTEV correlates significantly with the age of first presentation and has a strong positive correlation with both the initial Pirani score and the initial Dimeglio score.


CTEV; Ponseti method; Age; Pirani score; Dimeglio score.

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Cahyono BC. Congenital Talipes Equinovarus (CTEV). FK UNEJ Press. 2012.

Wallander HM. Congenital clubfoot Aspects on epidemiology, residual deformity and patient reported outcome. Acta Orthop Suppl. 2010.

Meena S, Sharma P, Gangary SK, Lohia LK. Congenital clubfoot. Journal of Orthopaedics & Allied Sciences. 2014.

Maranho DAC, Volpon JB. Congenital clubfoot. Acta Ortop Bras. 2011.

Rani M, Kumari P. Congenital Clubfoot: A Comprehensive Review. Orthopaedics and Rheumatology. 2017.

Bergerault F, Fournier J, Bonnard C. Idiopathic congenital clubfoot: Initial treatment. Orthop Traumatol Surg Res. 2013.

Besselaar AT, Sakkers RJB, Schuppers HA, et al. Guideline on the diagnosis and treatment of primary idiopathic clubfoot. Acta Orthop. 2017.

NSW. Management of infants and children with congenital talipes equinovarus. NSW Health. 2014.

Svehlik M Floh U, Steinwender G, Sperl M, Novak M, Kraus T. Ponseti method is superior to surgical treatment in clubfoot – long-term, randomized, prospective trial. Gait Posture. 2016.

Alves C, Escalda C, Fernandes Pm Tavares D, Neves MC. Ponseti Method Does Age at the Beginning of Treatment Make a Difference. Clin Orthop Relat Res. 2009.

Agarwal A, Gupta N. Does initial Pirani score and age influence number of Ponseti casts in children?. Int Orthop. 2014.

Aggarwal A, Gupta N. The Role of Pirani Scoring System in the Management and Outcome of Idiopathic Club Foot by Ponseti Method. International Journal of Science and Research. 2015.

D. Cosma, D. Vasilescu, M. Valeanu. Comparative results of the conservative treatment in clubfoot by two different protocols. J Pediatr Orthop B. 2007.

M. Dobbs, J.R. Rudzki, D.B. Purcell, T. Walton, K.R. Porter, C.A. GurnettFactors predictive of outcome after use of the Ponseti method for the treatment of idiopathic clubfeet. J Bone Joint Surg. 2006.

El Batti, Solla F, Clement JL, Oborocianu I, Chau E, and Rampai V. Initial treatment of congenital idiopathic clubfoot : Prognostic factors.Orthopaedics & Traumatology : Surgery & Research. 2016.

Dyer PJ, Davis N. The role of the Pirani scoring system in the management of clubfoot by the Ponseti method. J Bone Joint Surg. 2006.

Fan H Liu Y, Li Z, et al. The Correlation of Pirani and Dimeglio Scoring Systems for Ponseti Management at Different Levels of Deformity Severity. Scientific Reports. 2017.


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