Correction of a relapsed clubfoot after Ponseti Method

Abstract

Over the past few decades, surgical release has been nearly completely replaced by the Ponseti method for correcting idiopathic clubfoot, and the way this deformity is managed has changed significantly. Both the short-term and long-term functional outcomes of the Ponseti approach have been exceptionally good. Unfortunately, recurrence of the deformity is still a big concern; it affects as many as 40% of patients, and doctors still can't agree on how to treat recurrent clubfoot. Following initial surgical treatment with posteromedial release, there are a variety of options for managing a relapsed clubfoot deformity. These include casting, hemiepiphysiodesis, revised posteromedial release, osteotomies, fusion, and the use of gradual distraction with external fixators. Other methods that have been used in the past include the Ponseti method and tibialis anterior tendon transfer (TATT). This is covered in descending order of how intrusive they are. This study takes a look at the reported results, as well as the available evidence and limitations of the literature, regarding the treatment of relapses after the Ponseti method and initial surgical release. Relapse should be defined consistently with objective criteria for its control in future endeavors.