Late Presentation and Early Treatment Outcome Among Subjects in a New Clubfoot Program of a Nigerian Hospital

Background: Congenital talipes equinovarus imposes some functional compromise on the foot, resulting in structural adaptation or modification of the local anatomy in conformity with the direction of the structural stress that subserves the abnormal function. The success or otherwise of treatment is a measure of the degree of reversal of these structural adaptations and functional deficits. The aim of this study was to evaluate the early treatment outcome in the background of late presentation among subjects in a new clubfoot program of a Nigerian university teaching hospital. Methodology: A 6-month prospective, descriptive and health facility-based cross-sectional study of early treatment outcome of congenital talipes equinovarus among children in a Nigerian university teaching hospital is presented. Results: Sixty-seven children met the inclusion criteria and were recruited for this study. There was a slight preponderance of males over the females, with a male to female ratio of 1.6: 1. The mean age of the study population was 31.6 ± 23.64 months. In 45 (67.2%) children, the clubfoot was bilateral and unilateral in 22 (32.8%). Idiopathic clubfoot was the commonest variant at the rate of 70.1%. Thirty-nine (58.2%) had percutaneous tenotomy (Achilles tendon tenotomy), while 28 (41.8%) did not. The mean of the total initial Pirani score (4.61±1.18) was higher than that of the total final Pirani score (0.81 ± 0.49), with p < 0.001. The mean Pirani score of the left foot (4.78 ± 1.08) in the subjects who had percutaneous tenotomy was higher than that of subjects (3.83 ± 1.88) who did not have percutaneous tenotomy (p = 0.03). The odd of subjects with callosity to achieve correction at 10 or more cast was 11.8 times that of the subjects without callosity. On a logistic regression model, total initial Pirani score and callosity were independently significant (p < 0.05) in being associated with ≥10 castings for correction. For a unit increase in total initial Pirani score, the relative risk ratio of requiring ≥10 cast was 3.49 when the other variables are held constant in the logistic regression model. The relative risk ratio of requiring ≥10 cast for correction increased by 1.03 for a unit monthly increase in the age of the subject. Conclusion: Late presentation of clubfoot for treatment was common in this study. The Pirani score remained a reliable tool for assessing severity and monitoring treatment of clubfoot, and was valid across all age groups of clubfoot subjects seen in this study. In this study, it predicted the need or otherwise for percutaneous tenotomy, and correlated positively with the number of casting sessions required for correction.