Abstract
The Ponseti method has revolutionized clubfoot treatment. Though completely neglected clubfeet are now rare, partially or incompletely and improperly treated feet are not uncommon. Relapses after successful correction may occur due to non-compliance with bracing. In scarred soft tissues due to previous surgery, soft tissue distraction using external fixation helps achieve correction. The Ilizarov fixator permits us to follow the Ponseti protocol, using correction methods that may either be constrained or unconstrained by hinges. Applying force vectors perpendicular to the moment arm allows us to correct the еquinus without damaging the ankle joint. All of the above is possible when the talus is round. Full correction of the deformity is possible. However, longterm follow-up of these patients has revealed stiffness of the ankle setting and frequently with tibio-talar osteophytes anteriorly. They are probably a reaction to excessive pressure developed in the joint due to the tight soft tissues. Hence the author has now added a mild shortening of the tibia and fibula to reduce soft tissue tension, rather than resorting to further soft tissue releases through scarred tissues. This allows faster correction with the Ponseti-Ilizarov protocol and allows good ankle range of motion to persist.
Highlights
Relapsed or recurrent clubfeet in older children with large deformities and scarred soft tissues due and young adults are not uncommon, especially to previous surgery.CLINICAL EXAMINATIONOlder children and young adults may present with varying degrees of forefoot supination, cavus, hindfoot varus, and equinus
While most deformed clubfeet will have a tight equinus due to scarring from previous surgeries, a few may be partially correctible with the knee flexed
The configuration for the foot fixation depends upon whether the equinus deformity is accompanied by cavus or varus or valgus or there is no deformity between the hindfoot and forefoot
Summary
Older children and young adults may present with varying degrees of forefoot supination, cavus, hindfoot varus, and equinus. A rounded talus will allow good correction of the deformity by soft tissue distraction. We have used the Ponseti principles reliably with the Ilizarov fixator since the last 19 years at our institute to correct 62 recurrent and relapsed clubfeet.
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