Purpose: A retrospective study to determine the causes of failure of the Ponseti technique and treatment for those failed feet.

Materials and Methods: Eighty-nine patients with 136 clubfeet were treated by the Ponseti technique and evaluated on the Dimeglio/Bensahel and Catterall/ Pirani scoring systems. Six patients with 9 clubfeet were not corrected and therefore did not enter the dynamic ankle-foot orthosis stage. These 6 patients started treatment after the age of 8 months, except for one patient who was 9 weeks old at the start of treatment. Of these 9 feet, 8 underwent open Achilles tendon releases combined with posterior releases. Three of these feet had percutaneous Achilles tenotomies prior to their failure and 1 foot underwent complete soft tissue clubfoot releases. Eighty-three patients (127 clubfeet) completed the Ponseti technique. Eighteen patients with 28 club-feet were lost to 2-year follow-up (Group A), and 65 patients with 99 clubfeet (78.3%) had a greater than 2-year follow-up (Group B).

Results: Nine out of a total of 136 clubfeet failed the Ponseti technique. At 2-year follow-up, one-third (29/99) required additional procedure(s). At application of the dynamic ankle-foot orthosis in Group B, patients’ rating scores were similar. However, after 2-year follow-up, the noncompliant group’s scores (no orthosis) changed significantly for the worse when compared to the compliant group’s scores who used the orthosis for 2 years. After 2-year follow-up, Group B patients in the orthosis-compliant group had better scores than the 2-year failures (29 feet) who underwent further surgery and the initial 9 feet who failed the Pon-seti technique.