A RANDOMIZED COMPARATIVE STUDY OF THE PONSETI TECHNIQUE VERSUS THE KITE METHOD IN THE CONSERVATIVE MANAGEMENT OF IDIOPATHIC CONGENITAL TALIPES EQUINOVARUS

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Background: Clubfoot, also known as congenital talipesequinovarus (CTEV), is one of the most prevalent congenital
musculoskeletal deformities that are encountered in pediatric practice, and occurs in 1-3 per 1000 live births globally.Ponseti
technique and Kite method are two main conservative philosophies used to correct idiopathic clubfoot, however head to head
comparative evidence specific to the Indian tertiary care population (where the clubfoot is presented late, and there is
variation in brace compliance infrastructure) is limited.
Objective: To compare the clinical effectiveness of the Ponseti technique with the Kite method in reducing the severity of
idiopathic CTEV in children aged 0–1 year, efficiency of the treatment, necessity for tenotomy, recurrence of the deformity
and their complications.
Design: Randomized comparative study.
Setting: Department of Physiotherapy, Pacific Medical College and Hospital (PMCH), Bedla, Udaipur, Rajasthan.
Methods: There were a total of 50 children (0-1 year) with idiopathic CTEV were randomized equally into Group A
(Ponseti technique, n = 25) and Group B (Kite method, n = 25).The deformity severity was determined by Pirani and
Dimeglio scoring system at baseline and post treatment.Secondary outcomes included number of plaster-of-Paris casts,
duration of treatment, percutaneous Achilles tenotomy, dorsiflexion of the ankle after treatment, recurrence at 6 months, and
complication rate.Between-group comparisons were conducted using independent t-tests and Chi-square (α = 0.05).
Results: Groups were comparable at baseline (Pirani 4.75 ± 0.58 vs. 5.0 ± 0.50, p = 0.854; Dimeglio 13.68 ± 2.37 vs. 14.2 ±
1.89, p = 0.832). Group A achieved significantly greater Pirani score reduction (3.98 ± 0.79 vs. 2.60 ± 0.69; p < 0.001) and
Dimeglio score reduction (10.44 ± 3.18 vs. 4.4 ± 2.32; p < 0.001). The Ponseti group required fewer casts (6.8 ± 0.91 vs.
11.2 ± 1.41; p < 0.001), shorter treatment duration (7.24 ± 1.09 vs. 13.28 ± 1.83 weeks; p < 0.001), and achieved greater
post-treatment ankle dorsiflexion (15.4 ± 3.4° vs. 6.32 ± 2.41°; p < 0.001). The tenotomy was more often performed in
Group A (80% vs. 28%, p = 0.003) due to the protocol-driven equinuscorrection. Recurrence (16% vs. 28%, p = 0.002) and
complications (4% vs. 24%, p = 0.041) were both significantly lower in Group A.
Conclusions: The Ponseti technique achieved significantly better deformity correction, treatment efficacy and durability of
deformity correction than the Kite technique in this cohort, and should be used as the first-line conservative treatment in
resource-limited tertiary-care facilities for idiopathic CTEV.