Accelerated versus standard Ponseti method for idiopathic congenital talipes equinovarus: a systematic review and meta-analysis

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Background. The standard Ponseti method is a mainstay of treatment for children with congenital talipes equinovarus (CTEV); involving weekly manipulation and long-leg casting, this approach has proven to produce good long-term outcomes. However, it takes approximately 4–5 weeks to correct all deformity components, making compliance a challenge for patients with limited economic resources and difficulty reaching healthcare centres.

Aim. This study aims to compare treatment outcomes between standard Ponseti and an accelerated protocol — applying the same casts but changing them more frequently, every 2-5 days — for the CTEV pathology.

Methods. A systematic search was conducted based on PRISMA guidelines to identify relevant studies through PubMed, Google Scholar, and Cochrane Database. A total of seven studies (324 patients, 408 feet) were included in the meta-analysis. Five outcomes were compared between the two procedures: post-procedure Pirani score, relapse rate, tenotomy rate, number of casts, and total duration of treatment.

Results. For total duration of treatment, the accelerated Ponseti method was superior to standard Ponseti (24.25 vs. 41.54 days, p < 0.00001). On the other hand, it achieved comparable efficacy as measured by post-procedure Pirani score (1.01 vs. 0.87, p = 0.19). Furthermore, the two procedures were also comparable in terms of the total number of casts needed (4.94 vs. 5.05, p = 0.76), tenotomy rate (73.29% vs. 65.27%, p = 0.07) , and relapse rate (27.72% vs 25.23%, p = 0.56).

Conclusion. Accelerated Ponseti offers similar efficacy and shorter duration of treatment compared to the standard Ponseti technique.

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About the authors

Sherly Desnita Savio

Udayana University

Author for correspondence.
ORCID iD: 0000-0003-4269-1156

Indonesia, Bali

MD, Orthopaedic Resident, Orthopaedics and Traumatology Department, Faculty of Medicine Udayana University, Sanglah General Hospital

Made Agus Maharjana

Udayana University; Sanglah General Hospital

ORCID iD: 0000-0002-3953-2798

Indonesia, Bali

MD, Consultant of Orthopaedics and Traumatology Department, Faculty of Medicine Udayana University, Sanglah General Hospital


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Supplementary files

Supplementary Files Action
Figure: 6. Forest diagram of the results of the analysis of the number of relapses

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Fig. 1. Flowchart showing article selection based on PRISMA guidelines

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Fig. 2. Forest Plot analysis for duration of treatment

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Fig. 3. Forest Plot analysis for post-procedure Pirani Score

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Fig. 4. Forest Plot analysis for number of casts needed

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Fig. 5. Forest Plot analysis for tenotomy rate

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Fig. 6. Forest Plot analysis for relapse rate

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Critical appraisal of all studies included

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