Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Orthopedic Surgery

Objectives: To assess the value of Ponseti treatment of paralytic clubfeet in myelomeningeocele. Correction of the deformity according to Pirani score was assessed as primary outcome, feet pain, complication, relapse, these factors are also assessed as secondary outcomes Background: Myelomeningocele is a common birth defect that is often accompanied by clubfoot deformity. Treatment of clubfoot associated with myelomeningocele traditionally has consisted of extensive soft-tissue release operations, which are associated with many complications. Materials and methods: A prospective randomized study was conducted at Orthopedic surgery Department, Cairo University Hospital. Twenty-five children with myelomeningeocele and clubfeet under the age of 3 years were recruited in the study. Children above the age of 3 years and children with history of previous feet operation or any previous attempt of treatment were excluded. We underwent follow up of the children for six months .Results: Mean age of patients 13.96 ± 11.60 weeks with range (1 {u2013} 40 weeks). Majority of myelomeningocele patients was low lesions (L4) (60%) then patients with high lesions (L3) (28%). Only 8 patients develop local complication like foot ulcers and cellulitis. Patients needed soft tissue release after Ponseti method were 4 patients (16%). Number of cases relapsed after Ponseti method was 5 patients of 25 cases. Most of these patients (3 patients) relapsed after 5 months. The main outcome measure was the Pirani score, there is significant decrease of score post Ponseti method (.5) compared to pre- management (5.2) with p-value (.001)

Issued also as CD