Ponseti method under general anesthesia is an effective method of treatment for neglected congenital talipes equino varus: a cohort study. [version 1; peer review: 3 not approved]

Background:Neglected congenital talipes equino varus (CTEV) deformity is common in poorer developing countries. If ignored, children with CTEV result in callosity, potential bone and skin infection, and a significant mobility limitation resulting from stiffness. There are many management options that can be used to manage neglected CTEV. Until now, the Ponseti casting technique is a gold standard for treating CTEV without surgery. Ponseti methods effectively correct CTEV deformity in all ages. However, patients treated with the Ponseti process will suffer pain during correction in daily practice. Therefore, it is necessary to give anesthesia to reduce pain and relax soft tissues to achieve a satisfactory outcome when correction is carried out. Methods:This study design is a retrospective. Our study consisted of 32 patients, divided into two groups. Group A is the group that was treated with the Ponseti using general anesthesia (GA), and group B is the group without using GA. The children were anesthetized using isoflurane inhalation with 1-2 mcg/kg. After that, we performed serial casting every week and evaluated the outcome and number change cast between using GA and without GA. Lastly, we used a paired t-test statistical analysis to determine the relationship between before and after therapy. Results:In group A, the mean Pirani score significantly reduced from 5.81 ± 0.403 to 0.625 ± 0.40. In contrast with roup B, where the mean Pirani score slightly decreased from 5.81 ± 0.403 to 4.437 ± 1.093. After the last serial cast, in group A, only four cast replacements were needed to achieve a good outcome, whereas, in group B, the results remained unsatisfactory after 10 cast changes. Conclusions: Ponseti method under GA is an effective treatment and reduced the number of cast changes for neglected CTEV.