Ponseti Casting in Obtaining Correction of Non-idiopathic Clubfoot: Where do we Stand? A Tertiary Care Institution-Based Prospective Observational Study
Original Article | Volume 12 | Issue 2 | May-August 2026 | Page: 8-14 | Prashant Adhikari, Jeevan Kumar Sharma, Gaurav Bir Bajracharya, Tarun Rajbhandari, Bibek Banskota, Saurav Neupane, Isha Amatya, Ashok Kumar Baskota
DOI- https://doi.org/10.13107/ijpo.2026.v12.i02.270
Open Access License: CC BY-NC 4.0
Copyright Statement: Copyright © 2026; The Author(s).
Submitted: 24/04/2026; Reviewed: 19/05/2026; Accepted: 20/06/2026; Published: 10/08/2026
Authors: Prashant Adhikari [1,2], Jeevan Kumar Sharma [3], Gaurav Bir Bajracharya [1, 2], Tarun Rajbhandari [4, 5], Bibek Banskota [4, 5], Saurav Neupane [6], Isha Amatya [7], Ashok Kumar Baskota [4, 5]
[1] Department of Orthopaedics, Hospital for Advanced Medicine and Surgery, Kathmandu, Nepal.
[2] AaRuS Lifestyle Hospital, Kathmandu, Nepal,
[3] Indian Spinal Injuries Center, New Delhi, India,
[4] Department of Orthopaedics, Baidya and Banskota Hospital Pvt Ltd., Patan, Central Development Region, Nepal,
[5] Hospital and Rehabilitation Centre for Disabled Children, Orthopaedics, Banepa, Central Development Region, Nepal,
[6] Tribhuvan University Central Department of Rural Development, Kirtipur, Central Development Region, Nepal,
[7] Department of Orthopaedics, Patan Academy of Health Sciences, Lalitpur, Nepal.
Address of Correspondence
Dr. Prashant Adhikari,
Department of Orthopaedics, Hospital for Advanced Medicine and Surgery, Kathmandu, Nepal.
E-mail: adhikariprashant@hotmail.com
Abstract
Background: Clubfoot is a common congenital deformity, with idiopathic cases well managed by the Ponseti method. However, non‑idiopathic clubfoot (NICF), often associated with syndromic or neuromuscular conditions, remains challenging. Evidence on Ponseti casting in NICF is limited, and outcomes vary across etiologies.
Methods: This prospective observational study was conducted at a tertiary care center between September 2011 and September 2013. Out of 739 patients with clubfoot, 38 patients (59 feet) were diagnosed with NICF. Severity was assessed using Pirani and Diméglio scores. Ponseti casting was performed with weekly or accelerated cast changes, followed by Denis‑Browne splinting. Relapse and non-compliance were documented, and surgical interventions were tailored when casting failed.
Results: The majority of cases were due to Streeter’s dysplasia (36.9%) and arthrogryposis multiplex congenita (23.7%). All feet were rigid (Diméglio >5). Significant improvement in Pirani scores was observed across age groups (mean reduction from 5.2 ±1 to 2.9 ±1.4, P < 0.001). The mean number of casts required was 6.84, with Charcot‑Marie‑Tooth disease requiring the highest (13 casts). Correction was achieved in 61.7% of feet with casting ± heel cord release, while 38.3% required surgery. Relapse occurred in 18.9% of feet, mostly linked to splint non-compliance (31.6%). Parent‑reported satisfaction was high (78.9%).
Conclusion: Ponseti casting provides a reasonable success rate (61%) in NICF, particularly in younger age groups, and should be considered a first‑line treatment before surgical intervention. Despite higher rigidity and relapse rates compared to idiopathic cases, functional and cosmetic outcomes were satisfactory, with minimal complications.
Keywords: Dimeglio grading, non-idiopathic clubfoot, ponseti casting, pirani score, secondary clubfoot.
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| How to Cite this Article: Adhikari P, Sharma JK, Bajracharya GB, Rajbhandari T, Banskota B, Neupane S, Amatya I, Baskota AK Ponseti Casting in Obtaining Correction of | Non-idiopathic Clubfoot: Where do we Stand? A Tertiary Care Institution-Based Prospective Observational Study | International Journal of Paediatric Orthopaedics | May-August 2026; 12(2): 08-14. |
