Is it possible to treat recurrent clubfoot with the Ponseti technique after posteromedial release?: a preliminary study

Abstract

The Ponseti technique for treating clubfoot has been popularized for idiopathic clubfoot and more recently several syndromic causes of clubfoot. We asked whether it could be used to treat recurrent clubfoot following failed posteromedial release. We retrospectively reviewed 58 children (83 clubfeet) treated by the Ponseti technique for recurrent deformity after posteromedial release in three centers. The minimum followup was 24 months (average, 45 months; range, 24-80 months). We determined initial and final Pirani scores and range of motion of the ankle and subtalar joint. Plantigrade and fully corrected feet were obtained in 71 feet (86%); 11 feet obtained partial correction; one patient failed treatment and underwent another posteromedial release. Recurrences occurred in nine patients (12 feet or 14%). Initial Pirani scores improved in all but one patient; severity of deformity was also inferred by number of casts used for treatment. The age at treatment and numbers of casts did not influence the scores of Pirani et al. The scores were similar among the three orthopaedic surgeons.

Level of evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Fig. 1A–E

Photographs show a child aged 1 year 4 months with severe deformity on the left. (A) Posterior view, (B) anterior view, and (C) posterolateral view before treatment. (D) Anterior (E) and posterior view of the child’s feet after treatment.

Fig. 2A–E

Photographs show a child aged 4 years 11 months who had previous surgery when he was 8 months old: (A) Anterior view and (B) plantar view before the surgery, (C) during surgery, and (D) posterior and (E) plantar view after treatment with eight casts.

Fig. 3A–K

Photographs show a 5-year-old child with two previous surgeries. (A) Anterior view of the untreated feet and (B) the posterior view before treatment. (C) Anterior view of the treated feet and (D) the posterior view after treatment. (E) Plantar photograph before treatment; (F) anteroposterior radiographic view before treatment. Pretreatment photographs show a (G) Codivilla-type scar and a severe rigid cavus varus, adductus, and equinus deformity in the right foot. (H) Plantar photograph after treatment. (I) Radiographic anteroposterior and lateral views of the feet are shown; (J) the affected foot is shown; (K) the normal foot is shown.