Study of result of postero medial soft tissue release (PMSTR) in congenital talipes equinus varus (CTEV) children with Pirani score

Abstract

Specific Objectives: Congenital talipes Equinovarus (clubfoot) is most common congenital deformity of foot. It can be treated by PONSETI technique with high rate of success but surgery is indicated for rigid deformities that cannot be corrected by serial casting. In our study, our aim is to assess the outcome of Posteromedial Soft Tissue Release (PMSTR) in child with rigid CTEV by PIRANI score. Material and Methods: Between November 2018 to November 2019, we treated twenty (20) feet with idiopathic CTEV with PMSTR. All children with idiopathic clubfoot will be screened. First trial of CTEV cast will be given upto 3 casts. Child with clubfoot deformity which was not corrected with CTEV cast will be selected. Deformity will be assessed with pre-operative PIRANI score. Blood investigations and clinical examination will be done. Surgically fit child will be posted for POSTEROMEDIAL SOFT TISSUE RELEASE. After operative procedure, correction achieved is measured with immediate postoperative PIRANI score. Then above knee slab is given to patient up to stitch removal (12 days). Then after stitch is removed and above knee POP is applied to maintain correction. Patient is called at hospital at every 15 days. Old cast is removed and correction is assessed with PIRANI score. Below knee POP is applied at every 15 days and PIRANI score is assessed at every 15 days. Parents are encouraged to walk their child with cast. This procedure is followed until satisfactory correction is achieved (Usually 6-8 casts). Results: All 20 feets were treated between 7 months to 48 months age-group children with mean age of 19 months. Postoperatively the patients were followed up for every 15 days upto 6 month and everytime correction is noted with PIRANI score. According to these 20 feet evaluated. Among this, 12 children (60%) having excellent result with final PIRANI score <1. 4 children (20%) having good result with final PIRANI score <2. 4 children (20%) having fair result with final PIRANI score >2. Conclusion: From this study, we conclude that all children with Congenital Talipes Equino Varus (CTEV) deformity should be first treated with casting. All patients with a rigid idiopathic clubfoot should be given casts preoperatively, not with a view to achieve complete correction but only to stretch stretch the soft tissues and decrease the chances of post-operative skin breakdown. One stage Postero-medial soft tissue release is an excellent mode of treatment for those children with CTEV deformity which is not corrected by serial casting.