The evaluation of outcomes for neglected or relapsed club-foot managed with circular frame in a low-income country

K. Siwicka, A. Walls, K. James

Background: Worldwide the majority of club-feet are treated conservatively with the Ponseti method. However, in countries where resources and medical expertise are limited, neglected club-foot is commonly encountered and is often too late to respond to conservative treatment.

Objectives: To analyse the outcomes of patients treated with circular frame correction for neglected, resistant or relapsed congenital clubfoot (CTEV).

Methods: Between 2008 and 2016 twenty-seven patients with neglected or relapsed clubfoot have been treated with circular frame at Beit-CURE Hospital in Malawi. Ten patients were excluded from the study for valid reasons, leaving 19 patients with a total of 29 Ilizarov corrections. Evaluation of clinical outcomes included four scoring systems with objective and subjective components.

Results: Follow-up ranged from one to nine years. At review all patients reported an improvement in the shape and function of their feet. One patient had no deformity according to PAVER-score, sixteen mild, twelve moderate and none had severe deformity. According to ICSFG assessment, very good and good results were obtained in 12 feet, 16 fair and 1 scored poor. Ponseti functional rating showed similar results with ten feet classified as excellent and good, seventeen as fair and one had poor result.
Subjective outcomes measured with OxAFQ-C showed, with minor exceptions, patients´ overall satisfaction with the improvement of their feet function and appearance. Two patients reported less than good or very good physical results, all reported no or nearly no limitations at school, and only three reported less than 100% emotional satisfaction with their outcomes.

Conclusions: This case series of 29 relapsed or neglected clubfoot deformities managed by ilizarov correction, is the biggest of its kind found in the literature for a low-income country. The short term clinical and functional results of resistant clubfoot deformities with Ilizarov´s external fixator is promising and apparently a good option.