DOI: 10.14260/jemds/2014/2331 ORIGINAL ARTICLE J of Evolution of Med and Dent Sci/ eISSN- 2278-4802, pISSN- 2278-4748/ Vol. 3/ Issue 14/Apr 07, 2014 Page 3618 MODIFIED PONSETI TECHNIQUE FOR THE MANAGEMENT OF CONGENITAL TALIPES EQUINO VARUS (CTEV) IN NEONATES: OUR EXPERIENCE IN A RURAL TEACHING INSTITUTION Sharma Man Mohan 1 , Tiwari Pawan 2 , Sharma Shubham Mohan 3 , Tiwari Madhu 4 HOW TO CITE THIS ARTICLE: Sharma Man Mohan, Tiwari Pawan, Sharma Shubham Mohan, Tiwari Madhu. “Modified Ponseti Technique for the Management of Congenital Talipes Equino Varus (CTEV) In Neonates: our Experience in a Rural Teaching Institution”. Journal of Evolution of Medical and Dental Sciences 2014; Vol. 3, Issue 14, April 07; Page: 3618-3626, DOI: 10.14260/jemds/2014/2331 ABSTRACT: Congenital Talipes Equino Varus (CTEV) or clubfoot is a commonly seen congenital deformity of the foot. By this study, the results of Ponseti method of treatment of CTEV were evaluated in neonatal age group with little modification in the technique of percutaneous Achilles tenotomy. METHODS: It is a prospective study, conducted during the period of Dec. 2011 to July 2013 at the Department of orthopedics in the institute`s hospital. All the neonates born with CTEV were treated with this modified Ponseti casting technique. Neonates having other congenital deformities were excluded from the study. RESULTS: Total 33 CTEV feet of 20 neonates were treated. Thirteen were males and 7 were females. Twenty one (63.6%) feet were of rigid variety and 12(36.4 %) feet were of non-rigid variety. Thirteen patients had bilateral and 7 had unilateral involvement. In this study mean pre-treatment Pirani score was 5.55(±0.70) and mean number of plaster casts required per CTEV was 4.06 (range: 2-6). Percutaneous tenotomy was done in 19 rigid and 9 non- rigid (total 84.85%) feet. Out of 33 feet 31 (93.94%) were managed successfully. Two (6.06%) patients of rigid variety developed relapse of the deformity due to poor and faulty application of D-B Splint. Post-treatment mean Pirani score in this study group was 0.36(±0.42). CONCLUSION: For the treatment of CTEV deformity, the Ponseti technique is a simple, excellent, minimally invasive, effective, and less expensive and easy to learn procedure which is possible without general anesthesia even in neonates. KEYWORDS: Neonate, Ponseti technique, Talipes equino-varus. INTRODUCTION: Clubfoot or Congenital Talipes Equino Varus (CTEV) is a commonly seen complex congenital deformity of the foot. Depending on the race its incidence has been reported varying from 0.39 per 1000 to 6.8 per 1000 1, 2 and about 2.5 times more commonly seen in males. 3 Idiopathic CTEV occur in isolation while syndromic CTEV as a part of other congenital anomalies like meningomyelocele, arthrogryposis etc. Various etiologic hypotheses have been reported varying from germplasm defects, intra-uterine molding, and intra-uterine developmental arrest to myogenic, neurogenic and vascular explanations. The deformity consists of four components: equinus at ankle, varus at hind foot, adductus at forefoot, and cavus deformity at midfoot. 4 Various clubfoot treatment modalities include manipulations, plaster casts, strapping, splintage, passive motion, surgery (limited and extensive). 5 Recently there has been shown successful results with Ponseti's method of manipulation and serial casting. 6-8 Few studies 9-11 reported good results at short term follow up in infants where treatment could be started during earlier few months of life and who had not taken any other treatment prior to