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Review
. 2021 Jul;9(13):1102.
doi: 10.21037/atm-20-7730.

Narrative review of the management of a relapsed clubfoot

Karim Masrouha  1 , Alice Chu  2 , Wallace Lehman  1
Affiliations
Review

Narrative review of the management of a relapsed clubfoot

Karim Masrouha et al. Ann Transl Med. 2021 Jul.

Abstract

The management of idiopathic clubfoot has transformed over the past several decades as the Ponseti method for the correction of this deformity became the standard of care, and surgical release has almost all but been abandoned. The Ponseti method has shown very high initial success rate and excellent long-term functional results. Relapse of the deformity, however, continues to be a major problem, occurring in up to 40% of patient, and there is no consensus on the definition and management of the relapsed clubfoot. This review discusses the available management options for the treatment of a relapsed clubfoot deformity following initial treatment with the Ponseti method [including repeat casting, tendo-Achilles lengthening, plantar fascia release, and tibialis anterior tendon transfer (TATT)] as well as following initial surgical treatment with posteromedial release (including casting, hemiepiphysiodesis, revised posteromedial release, osteotomies, fusion, and the use of gradual distraction with external fixators). These are discussed from the least to the most invasive. Available evidence, and limitations of the literature, for the management of relapses following both the Ponseti method and initial surgical release is reviewed along with along with the reported outcomes. Future efforts should be geared towards standardizing the definition of a relapse with objective criteria for its management.

Keywords: Clubfoot; Ponseti method; relapse; surgery.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/atm-20-7730). The series “Clubfoot” was commissioned by the editorial office without any funding or sponsorship. The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
Clinical image of a patient with bilateral relapse of all components of the deformity.
Figure 2
Figure 2
Clinical image of the right foot of a child demonstrating dynamic supination with attempted ankle dorsiflexion.
Figure 3
Figure 3
Clinical images of the (A) medial and (B) lateral aspects of the right foot of a patient who relapsed following extensive surgical release.
Figure 4
Figure 4
(A) Sagittal and (B) coronal clinical images of the left foot of a patient who underwent gradual corrections using a hexapod frame.
See this image and copyright information in PMC

References

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