Relapse Following Use of Ponseti Method in Idiopathic Clubfoot

Overview

Journal J Child Orthop

Publisher Sage Publications

Specialty Pediatrics

Date 2019 Jan 5

PMID 30607203

Citations 13

Authors

S Chand

A Mehtani

A Sud

J Prakash

A Sinha

A Agnihotri

Affiliations

Soon will be listed here.

Abstract

Purpose: We assessed the pattern of relapse as well as the correlation between the number of casts required for correction and Pirani and Dimeglio scores at presentation, and age at presentation. We hypothesized that the Ponseti method would be effective in treatment of relapsed clubfoot as well.

Methods: We evaluated 115 idiopathic clubfeet in 79 children presenting with relapse following treatment by the Ponseti method. The mean age was 33.8 months with mean follow-up of 24 months. All patients were assessed for various patterns of relapsed deformities. Quantification of deformities was done using the Pirani and Dimeglio scores. All relapsed feet were treated by a repeat Ponseti protocol.

Results: Non-compliance to a foot abduction brace was observed to be the main contributing factor in relapse, in 99 clubfeet (86%). Combination of three static deformities (equinus, varus and adduction) together was observed most commonly (38.3% feet). Overall, relapse of equinus deformity was noted most commonly followed by adduction. A painless plantigrade foot was obtained in all 115 feet with a mean of five casts. In all, 71 feet (61.7%) underwent percutaneous tenotomy. A total of 15 feet (13%) required tibialis anterior tendon transfer. Re-relapse rate in group 1 was 21% compared with 12.6% in group 2 and overall 16.5%.

Conclusion: We conclude that the Ponseti method is effective and the preferred initial treatment modality for relapsed clubfeet. Surgical intervention should be reserved for residual deformity only after a fair trial of Ponseti cast treatment. Regular follow-up and strict adherence to brace protocol may reduce future relapse rates. Further research is required to identify high-risk feet and develop individualized bracing protocol.

Level Of Evidence: IV.

Citing Articles

Repeating Ponseti method for treating relapsed idiopathic congenital talipes equinovarus in children less than two years of age: a prospective study.

Ahmed K, Marzouk A, Eldin M BMC Musculoskelet Disord. 2025; 26(1):263.

PMID: 40087635 DOI: 10.1186/s12891-025-08464-8.

Mohsenh W, Alqarni M, Alshehri A, Asiri A, Mohsenh O, Mahmood S Cureus. 2023; 15(8):e43701.

PMID: 37724225 PMC: 10505498. DOI: 10.7759/cureus.43701.

Tibialis anterior tendon transfer using suture anchor provides excellent alternative treatment for relapse clubfoot: A case report.

Anastasia M, Pramantha B, Kholinne E, Anestessia I Int J Surg Case Rep. 2023; 106:108270.

PMID: 37156200 PMC: 10195990. DOI: 10.1016/j.ijscr.2023.108270.

Comparison of outcome of Ponseti method with traditional clubfoot treatment in children up to five years of age at tertiary care hospital.

Yaqeen A, Sidra H, Ijaz M, Ijaz M Pak J Med Sci. 2022; 38(6):1680-1685.

PMID: 35991272 PMC: 9378408. DOI: 10.12669/pjms.38.6.5519.

Anatomical Structures Responsible for CTEV Relapse after Ponseti Treatment.

Laliotis N, Chrysanthou C, Konstandinidis P, Anastasopoulos N Children (Basel). 2022; 9(5).

PMID: 35626758 PMC: 9139296. DOI: 10.3390/children9050581.

References

Dobbs M, Rudzki J, Purcell D, Walton T, Porter K, Gurnett C . Factors predictive of outcome after use of the Ponseti method for the treatment of idiopathic clubfeet. J Bone Joint Surg Am. 2004; 86(1):22-7. DOI: 10.2106/00004623-200401000-00005. View

Mahan S, Spencer S, May C, Prete V, Kasser J . Clubfoot relapse: does presentation differ based on age at initial relapse?. J Child Orthop. 2017; 11(5):367-372. PMC: 5643930. DOI: 10.1302/1863-2548.11.170016. View

Ippolito E, Farsetti P, Caterini R, Tudisco C . Long-term comparative results in patients with congenital clubfoot treated with two different protocols. J Bone Joint Surg Am. 2003; 85(7):1286-94. DOI: 10.2106/00004623-200307000-00015. View

Ponseti I . Relapsing clubfoot: causes, prevention, and treatment. Iowa Orthop J. 2002; 22:55-6. PMC: 1888384. View

Dobbs M, Nunley R, Schoenecker P . Long-term follow-up of patients with clubfeet treated with extensive soft-tissue release. J Bone Joint Surg Am. 2006; 88(5):986-96. DOI: 10.2106/JBJS.E.00114. View

Bhaskar A, Patni P . Classification of relapse pattern in clubfoot treated with Ponseti technique. Indian J Orthop. 2013; 47(4):370-6. PMC: 3745691. DOI: 10.4103/0019-5413.114921. View

Avilucea F, Szalay E, Bosch P, Sweet K, Schwend R . Effect of cultural factors on outcome of Ponseti treatment of clubfeet in rural America. J Bone Joint Surg Am. 2009; 91(3):530-40. DOI: 10.2106/JBJS.H.00580. View

Mehtani A, Prakash J, Vijay V, Kumar N, Sinha A . Modified Ponseti technique for management of neglected clubfeet. J Pediatr Orthop B. 2017; 27(1):61-66. DOI: 10.1097/BPB.0000000000000450. View

Refai M, Song S, Song H . Does short-term application of an Ilizarov frame with transfixion pins correct relapsed clubfoot in children?. Clin Orthop Relat Res. 2012; 470(7):1992-9. PMC: 3369077. DOI: 10.1007/s11999-012-2289-4. View

10.

Dimeglio A, BENSAHEL H, Souchet P, Mazeau P, Bonnet F . Classification of clubfoot. J Pediatr Orthop B. 1995; 4(2):129-36. DOI: 10.1097/01202412-199504020-00002. View

11.

Aronson J, Puskarich C . Deformity and disability from treated clubfoot. J Pediatr Orthop. 1990; 10(1):109-19. View

12.

van Bosse H . Treatment of the neglected and relapsed clubfoot. Clin Podiatr Med Surg. 2013; 30(4):513-30. DOI: 10.1016/j.cpm.2013.07.006. View

13.

Abdelgawad A, Lehman W, van Bosse H, Scher D, Sala D . Treatment of idiopathic clubfoot using the Ponseti method: minimum 2-year follow-up. J Pediatr Orthop B. 2007; 16(2):98-105. DOI: 10.1097/BPB.0b013e32801048bb. View

14.

Morcuende J, Dolan L, Dietz F, Ponseti I . Radical reduction in the rate of extensive corrective surgery for clubfoot using the Ponseti method. Pediatrics. 2004; 113(2):376-80. DOI: 10.1542/peds.113.2.376. View

15.

Owen R, Kembhavi G . A critical review of interventions for clubfoot in low and middle-income countries: effectiveness and contextual influences. J Pediatr Orthop B. 2011; 21(1):59-67. DOI: 10.1097/BPB.0b013e3283499264. View

16.

Chu A, Lehman W . Persistent clubfoot deformity following treatment by the Ponseti method. J Pediatr Orthop B. 2011; 21(1):40-6. DOI: 10.1097/BPB.0b013e32834ed9d4. View

17.

Luckett M, Hosseinzadeh P, Ashley P, Muchow R, Talwalkar V, Iwinski H . Factors predictive of second recurrence in clubfeet treated by ponseti casting. J Pediatr Orthop. 2014; 35(3):303-6. DOI: 10.1097/BPO.0000000000000248. View

18.

Masrouha K, Morcuende J . Relapse after tibialis anterior tendon transfer in idiopathic clubfoot treated by the Ponseti method. J Pediatr Orthop. 2011; 32(1):81-4. DOI: 10.1097/BPO.0b013e31823db19d. View

19.

Laaveg S, PONSETI I . Long-term results of treatment of congenital club foot. J Bone Joint Surg Am. 1980; 62(1):23-31. View

20.

Zhao D, Liu J, Zhao L, Wu Z . Relapse of clubfoot after treatment with the Ponseti method and the function of the foot abduction orthosis. Clin Orthop Surg. 2014; 6(3):245-52. PMC: 4143509. DOI: 10.4055/cios.2014.6.3.245. View