Relapsing clubfoot with Ponseti method: cause and treatment

Abstract

Objective To analyze the cause and treatment of relapsing clubfoot with Ponseti method. Methods Four hundred and seventy eight cases (male 386 and female 92) with 714 feet (bilateral in 236 cases, single foot in 242) were managed with Ponseti method in this hospital from Jan. of 2000 to Apr. of 2008. According to the Dimeglio classification:Type Ⅰ 29 feet, Type Ⅱ 275 feet, Type Ⅲ 308 feet and Type Ⅳ 102 feet. All were treated with serial cast, percutaneous Achilles tenotomy and brace with an abduction orthosis. All cases got regular follow-up. Relapsing were recorded, the relation between the type, using of brace and the recurrence were analyzed. The relapsing patients were treated with recasting for 4 or 5 times, and then percutaneous Achilles tenotomy and/or anterior tibial tendon transfer according to the different types. Results All cases were given follow-up visit. Eighty-nine feet of 714 feet recurred (12. 46%), 26 in type Ⅱ, 30 in type Ⅲ, and 33 in type Ⅳ. Relapses occurred in 6. 01% (38 feet) of the 632 feet which were compliant with brace while 62. 20% (52 feet) of 82 un-compliant patients. The main age of recurrence was 2 to 2. 5 years old and the main deformities were equino and varus. These recrudescent ones were corrected with advance casting for 4 or5 times. Eighteen feet underwent percutaneous Achilles tenotomy, 61 feet underwent anterior tibial tendon transfer and 10 got both surgery. All the patients got excellent results at last (average 38 months of follow-up). Conclusions The two factors for the recurrence of clubfoot treated with the Ponseti method are the compliance with the brace and the severity of the deformity. The recurrence is usually expected 2 to 4 months after the brace was given up and the main deformities were equino and varus. All the recrudescent would be corrected with recasting for 4 or 5 times, then undergoing percutaneous Achilles tenotomy and/or anterior tibial tendon transfer in the light of the different types. Key words: Equinus deformity; Recurrence