EVALUATION OF THE APPLICATION OF PONSETI METHOD: IN CONTEXT OF

BANGLADESH

AUTHORS:

HM Baker1, S Khan1, MOF Faisal1, PC Banik2

1Zero Clubfoot, A Project of Lion Mukhlesur Rahman Foundation, Chittagong, Bangladesh;2Department of Community Medicine, Bangladesh University of Health Sciences, Dhaka, Bangladesh

BACKGROUND

Even Bigger than

Russia

8th Largest Country of the WORLD

166,280,712 (July 2014 est.)

www.cia.gov/library/publications/the-world-factbook/geos/bg.html

Even Bigger than

Russia

3,074,186

http://www.worldpopulationstatistics.com/iowa-population-2013www.cia.gov/library/publications/the-world-factbook/geos/bg.html

IOWA

145,743 sq km 143,998 sq km

166,280,712

BACKGROUND

In 2020, Population of Bangladesh will be Total

180 Million

Among them nearly

18 million* will be

DISABLED

*While no reliable national data exist, anecdotal information and a number of micro studies generally suggest a disability prevalence rate of between 5 to 12 per cent. This is close to the WHO estimate, which states that 10 per cent of any given population can be considered to have some or other form of disability.

Bangladesh Picture

Every year, at least 5000 children are born with a clubfoot deformity in Bangladesh.

Around 1000 children born with clubfoot in CHITTAGONG division each year.

…..That is 2 - 3 babies every day!!!

Started on July 2009

Started on Feb 2010

Our Fight against Clubfoot

Existing clinics District

Lion Mukhlesur Rahman Plastic Surgery Hospital Chittagong

Ramu Upazila Health Complex Cox’s Bazar

Khagrachhari Govt. Sadar Hospital Khagrachhari

Comilla Medical College Hospital Comilla

Noakhali Govt. Sadar Hospital Noakhali

Chandpur Govt Sadar Hospital Chandpur

Brahmanbaria Govt. Sadar Hopital Brahmanbaria

Feni Govt. Sadar Hospital Feni

Laxmipur Govt. Sadar Hospital Laxmipur

Clinics

• ZCF provides world famous Ponseti treatment.

• ZCF also perform surgery for those who are neglected.

• All services are free of cost.

Since inception on 2010, Zero Clubfoot project of LMRF has been playing a very crucial role in setting up a system of early detection and treatment of Clubfoot in Chittagong Division.

• Local Capacity Building• Train up Doctors & Physiotherapists to treat clubfoot and

Cleft lip by proper technique.• Train Doctors, Nurses and other Health care workers to detect these

deformities at early stage.

• Decentralization• Direct intervention at Free of Cost• Awareness buildup• Partnership

Key QuestionIs the Ponseti method applicable for treatment of clubfoot Children in context of Bangladesh?

General Objectives: The aims of the present study

was to evaluate the application of the Ponseti method when used for the treatment of clubfoot children of Bangladesh

Specific Objectives:To understand the Gender

ratio of among clubfoot babyTo understand the foot

involvement of among clubfoot baby

To understand the ratio of type of clubfoot

To understand the rate of tenotomy among corrected clubfoot children.

Objectives

Study Areas: ComillaChadpur & Bhrahman Baria district of Bangladesh

Barriers1. Lack of necessary facility2. Lack of Quality Human Resource3. Lack proper awareness on

available treatment4. Traditional false beliefs

Study Design: This is an observational follow up study

Sample size: 281 clubfoot baby (433 Feet)Study period: Jan 2011 to Jan 2014

Data collection: Socioeconomic data collected by structured

questionnaire Clinical data collected from medical record of the

baby ( Clinical Database)

Data analysis:Univariate and bivariate analysis was done

accordingly as appropriate by using SPSS software version 16 for windows system.

Methodology

Methodology ( Cont…)Treatment Procedure: Ponseti MethodManipulation and Serial Plaster –

Every Week

Achilles Tenotomy (When 15 degree of Dorsiflexion not achieved through manipulation and casting)

Follow-up with FAB Foot Abduction Brace – Steenbeek (Bangla Brace)

23 hours per Day for consecutive 3 monthsAfter that 12 - 14 hours (night and nap Brace)

upto 5 years of age.

Treatment

Provider:

Trained Physiothrapists on Ponseti Technique performed Assessment and Scoring Manipulation Casting Bracing and follow up

Tenotomy done by the

Orthopedic surgeons of 3 Govt. District Hospitals

Working with Govt

Orthopedic

surgeons

ResultsTotal Patients (clubfoot baby)= 281 (433 Feet)

Male patients ( clubfoot baby)=193 (66.3%)

Female patients ( clubfoot baby)=88 (33.7%)

Male Female ratio: 2:1The mean (±SD) age of the babies was = 6 (±4) months.

Foot involvement:Bilateral ( both feet) – 152

Unilateral ( single foot) – 129

Unilateral & bilateral ratio: 0.85

66.30%

33.70%

Male Female

152Bilateral

Unilateral

129

Results: Types of Clubfoot

Total Patient Idiopathic Atypical Syndromic

281 260 (92%) 16 (5%) 5 (3%)

IdiopathicAtypicalSyndromic

Results: Averagecasts needed

Total Clubfoot Children

1 to 3 casts

4 to 6 casts

7 to 10 casts

11 to 15 casts

281(100%)

65 (23.1%)

126 (44 %)

80 (28.4%)

10(3.5%)

65

126

80

10 1 to 3 casts

4 to 6 casts

7 to 10 casts

11 to 15 casts

Results (Cont….)

Total Clubfoot Baby

Correction achieved by Ponseti Method

Correction achieved by PMR

Surgery

Dropped during Casting Phase

281(100%) 230 (82%) 12 (4.3%) 39 (13.7%)

Total Patients Correction achieved by

Ponseti Method

Correction achieved by

Surgery

Dropped during Casting phase

0%

20%

40%

60%

80%

100%

120%

Correction achieved by

Ponseti MethodThrough Tenotomy Without

Tenotomy

230 (100%) 164(71.3%) 66 (28.7%)

Correction achieved by Ponseti Method

Through Tenotomy Without Tenotomy0%

20%

40%

60%

80%

100%

120%

Results (Cont….)

Conclusion

• More than eight among each ten babies were cured successfully by the initial application of Ponseti technique.• Later effect of Ponseti technique could not be measured due to lack of follow-up• About 1/3 of the total babies had ruled out from the Follow up phase for some several reasons which should pursue special attention.

MONITORING ….

WE FEEL PROUD TO CHANGE THESE LIVES……

World Clubfoot Day Celebration 2013