Clubfoot Clinic Audit: Our Experience of 5 Years (2015–2019)

Introduction: Clubfoot clinic is a specialty service by the department of orthopedics. Its clinical audit is essential to know the outcomes, relapse and cast-related complications. Materials and Methods: After ethical clearance, 118 clubfoot patients aged 0–12 years, reported within 2015–2019 were assessed. Those with clubfoot-like deformity due to limb deficiency, post burn contracture, post traumatic contracture, tibiofibular diastasis and lost in follow-up were excluded. Observations and Results: 50% children had bilateral involvement, and the right foot (35.6%) was affected more in the remaining half. Boys were affected thrice than girls. Among all clubfeet, idiopathic was the most common (80%), followed by syndromic (10.16%) and least common was neurological (9.32%). Atypical clubfoot was noticed in 8.47% patients. 70% of children presented within 1 year. All the patients were treated by the Ponseti method of casting and tenotomy. The average number of casts required was 5 in idiopathic, 7 in syndromic, 6 in neurological and 8.71 in atypical clubfoot. 13 (11%) patients required more than 10 casts due to atypical changes, arthrogryposis multiplex congenita, persistent forefoot adduction, subtalar dysplasia, fungal skin infection, peroneal palsy, and poor compliance with the casting protocol. Tenotomy was required in 65.5% cases. Those having supple and braceable feet and with postural deformity did not require tenotomy. 30% patients required repeat tenotomy due to poor bracing, inadequate tenotomy, anomalous tendon, abnormal lateral sleeve and broad tendon. Plantar fasciotomy was required in late-presenting cases to correct the cavus deformity in 13 (11%) children. Relapse was noted in 28 patients (23.72%), with the highest incidence in neurological clubfoot (45%). Post cast complications, such as tight plaster, skin abrasions, cast slipping out, and cast breakage, were noted. Conclusion: To prevent delayed presentation, relapses and complications in clubfoot children, judicious casting technique, dedicated use of braces and their timely change, attentive physician and parental awareness are essential. Trained Anganwadi and Asha workers in villages can act as pillars in early detection, follow-up and as counsellors.