Ponseti method has become the most common and validated initial non-operative and/or minimally invasive treatment modality of idiopathic clubfoot regardless of the severity of the deformity worldwide. Despite hundreds of publications in the literature favoring Ponseti method, the data about secondary procedures performed in the follow-up period of clubfoot and their incidence remains sparse and given as small details in the articles. The objective of this study was to analyse our incidence of secondary procedures performed in the midterm followup period of idiopathic clubfoot patients treated with Ponseti method and review of the relevant literature. For this purpose 86 feet of 60 patients with idiopathic clubfoot who were treated with original Ponseti method were enrolled in this retrospective case control study. Unilateral ankle foot orthosis (AFO) was used rather than standart bar-connected foot abduction orthosis varying from 12 months to 25 months in the follow-up period and 74 of 86 (86%) feet required percutaneous achilles tenotomy. The average age of initial cast treatment was 12.64 days (range 1 to 102 days). The mean follow-up time was 71 months (range 19 to 153 months). Thirty seven feet of 24 patients recieved secondary procedures (43%) consisting of; supramalleolary derotational osteotomy (SMDO) (1 patient/2 feet), complete subtalar release (3 patients/5 feet), medial opening lateral closing osteotomy (double osteotomy) (2 patients/3 feet), double osteotomy with transfer of tibialis anterior tendon (TTAT) (2 patients/3 feet), partial subtalar release (PSTR) (3 patients/5 feet), PSTR with SDO (1 patient/1 foot), posterior release (PR) with repeated achillotomy (1 patient/2 feet), TTAT (6 patients/10 feet), TTAT with PR (2 patients/2 feet), TTAT with Vulpius procedure (1 patient/1 foot) and TTAT with SMDO (2 patients/3 feet) respectively. The amount of percutaneous achilles tenotomy (86%) in our study correlated with the literature which ranged from 80 to 90 %. The transfer of tibialis anterior tendon continued to be the most performed secondary procedure both in our study (51%) and in the literature, but the amount of total secondary procedures in our study (43%) was determined to be higher than the literature data varying from 7 to 27 percent which may be due to unilateral AFO application after Ponseti method for idiopathic clubfoot deformity in our study

We present a systematic review of the results of the Ponseti method of management for congenital talipes equinovarus (CTEV). Our aims were to assess the method, the effects of modifications to the original method, and compare it with other similar methods of treatment. We found 308 relevant citations in the English literature up to 31 May 2010, of which 74 full-text articles met our inclusion criteria. Our results showed that the Ponseti method provides excellent results with an initial correction rate of around 90% in idiopathic feet. Non-compliance with bracing is the most common cause of relapse. The current best practice for the treatment of CTEV is the original Ponseti method, with minimal adjustments being hyperabduction of the foot in the final cast and the need for longer-term bracing up to four years. Larger comparative studies will be required if other methods are to be recommended

Aims. The Ponseti method is an effective evidence-based treatment for clubfoot. It uses gentle manipulation to adjust the position of the foot in serial treatments towards a more physiological position. Casting is used to hold the newly achieved position. At first, the foot resists the new position imposed by the plaster cast, pressing against the cast, but over time the tissues are expected to adapt to the new position and the force decreases. The aim of this study was to test this hypothesis by measuring the forces between a clubfoot and the cast during treatment with the Ponseti method. Patients and Methods. Force measurements were made during the treatment of ten idiopathic clubfeet. The mean age of the patients was seven days (2 to 30); there were nine boys and one girl. Force data were collected for several weeks at the location of the first metatarsal and the talar neck to determine the adaptation rate of the clubfoot. Results. In all measurements, the force decreased over time. The median (interquartile range) half-life time was determined to be at 26 minutes (20 to 53) for the first metatarsal and 22 minutes (9 to 56) for the talar neck, suggesting that the tissues of the clubfoot adapt to the new position within several hours. Conclusion. This is the first study to provide objective force data that support the hypothesis of adaptation of the idiopathic clubfoot to the new position imposed by the cast. We showed that the expected decrease in corrective force over time does indeed exist and adaptation occurs after a relatively short period of time. The rapid reduction in the forces acting on the foot during treatment with the Ponseti method may allow significant reductions in the interval between treatments compared with the generally accepted period of one week

Incidence of Congenital talipes equino varus [CTEV] is 1 to 2 per 1000 birth, Out of all cases 20% cases are Non-idiopathic. The management of non-idiopathic CTEV, however, continues to be challenging due to Rigidity, Poor skin condition, Bony changes, Vascularity and Associated congenital abnormalities. In recent literature, short term results of Ponseti method for correction of non-idiopathic CTEV have been encouraging. As Ponseti method decreases the severity of deformity and hence decreases the need for extensive surgery. The aim of current study is to evaluate the results of Ponseti method in Non-idiopathic CTEV. Total 7 children below the age of one year with Non idiopathic clubfoot presented to us in the duration of 2013 to 2015 who were treated by us. The cases included are Streeters Dysplasia with congenital constriction rings 3, Arthrogryposis multiplex congenita with Developmental dysplasia of hip 2, Arthrogryposis multiple congenita spina Bifida 1, Pierre Robinson Syndrome with Ichthiosis 1. Initially all the patients treated with Ponseti casting technique and scoring was done using modified pirani scoring. At an average we could correct the foot from Pirani 7 to 2.5 with a relapse in 4 patients. 2 patients were treated again by Ponseti's method with success while treatment was discontinued in 2 feet. We recommended Ponseti's technique in Syndromic clubfoot as an non-surgical initial modality with good results given. The final outcome may depend more on the underlying condition than the CTEV

We conducted a prospective randomised controlled trial to compare the standard Ponseti plaster method with an accelerated method for the treatment of idiopathic congenital talipes equinovarus. The standard weekly plaster-change method was accelerated to three times per week. We hypothesised that both methods would be equally effective in achieving correction. A total of 40 consecutive patients (61 feet) were entered into the trial. The initial median Pirani score was 5.5 (95% confidence interval 4.5 to 6.0) in the accelerated group and 5.0 (95% confidence interval 4.0 to 5.0) in the standard control group. The scores decreased by an average 4.5 in the accelerated group and 4.0 in the control group. There was no significant difference in the final Pirani score between the two groups (chi-squared test, p = 0.308). The median number of treatment days in plaster was 16 in the accelerated group and 42 in the control group (p < 0.001). Of the 19 patients in the accelerated group, three required plaster treatment for more than 21 days and were then assigned to the standard control method. Of the 40 patients, 36 were followed for a minimum of six months. These results suggest that comparable outcomes can be achieved with an accelerated Ponseti method. The ability to complete all necessary manipulations within a three-week period facilitates treatment where patients have to travel long distances

The Ponseti method of treating club foot has been shown to be effective in children up to two years of age. However, it is not known whether it is successful in older children. We retrospectively reviewed 17 children (24 feet) with congenital idiopathic club foot who presented after walking age and had undergone no previous treatment. All were treated by the method described by Ponseti, with minor modifications. The mean age at presentation was 3.9 years (1.2 to 9.0) and the mean follow-up was for 3.1 years (2.1 to 5.6). The mean time of immobilisation in a cast was 3.9 months (1.5 to 6.0). A painless plantigrade foot was obtained in 16 feet without the need for extensive soft-tissue release and/or bony procedures. Four patients (7 feet) had recurrent equinus which required a second tenotomy. Failure was observed in five patients (8 feet) who required a posterior release for full correction of the equinus deformity. We conclude that the Ponseti method is a safe, effective and low-cost treatment for neglected idiopathic club foot presenting after walking age

Clubfoot deformity is the most common congenital musculoskeletal disorder (1). Approximately one in one thousand people are born with at least one clubfoot; between 150,000 and 200,000 babies are born with a clubfoot each year (2). Eighty percent of these cases occur in developing countries, and the majority is left untreated. When infants are treated with a non-invasive casting technique pioneered by Ignacio Ponseti M.D., they generally can be “cured” with relative ease. In the United States, 97% of patients given this treatment can walk successfully and are able to live normal lives (3). The Ponseti Method requires several plaster casts but either no or minimal surgery, can be taught fairly easily not only to doctors but also to healthcare workers, nurses, and other people who have some knowledge and training in healthcare. Also, it requires plaster casting, making it an inexpensive treatment. Dr. Ignacio Ponseti first performed his non-invasive treatment in 1949, but didn't publish his results until 1963. Two more papers, published in 1979 and 1995 described the long-term outcomes of treatment. In 1996 Oxford Press published a book detailing his approach. Although the treatment has always had high success rates, a lack of publicity prevented it from becoming more widely used until the late 1990s. Its basic mechanism consists of a series of plaster casts and manipulations that gradually reshape the foot around a fixed talus to obtain correction. Generally, between five and seven casts are required. The casts extend from the toes to the upper thigh and hold the knees at a right angle. One of the most important aspects of this method is timing: infants can be given treatment starting at seven days old and ideally should begin treatment before reaching eight months of age. Brazil, Uganda, Malawi and Chile now have official national programs, which are sponsored by each country's Ministries of Health, in which clinics in each country treat clubfoot disorder using the Ponseti Method. China set up a national program in 2005, but with a population of 1.3 billion people, it will take several years to complete the training. The prevalence of the Ponseti Method varies in the sixty other countries with healthcare workers trained in the treatment. This talk will review the principles of treatment and focus on results of recurrence after initial treatment with the Ponseti Method

Introduction: The Ponseti method has been adopted by many pediatric orthopaedic centers throughout Europe in the last years. The minimal invasive approach and the short duration of the active treatment phase have been the main reasons to change to the Ponseti method at our institution. We report the short term results of patients treated with the Ponseti method for idiopathic clubfeet and discuss experiences and pitfalls. Material and Methods: From the end of 2002 on we have applied the treatment regime strictly as described by Ponseti himself. For this study we analyzed a group of patients comprising all patients treated for congenital idiopathic clubfoot according to the Ponseti protocol within the first three weeks after births. The need for open release surgery was the main outcome measurement in this group. Results: Between December 2002 and July 2004 we treated a total of 59 clubfeet in 37 patients with the Ponseti method. Our patient population consisted of 14 female and 23 male patients. The mean Dimeglio score was 9.2 points (5–15 points). Using the Pirani score the mean midfoot score was 1.7 points (1–3 points), the mean hindfoot score was 2 points (0.5–3 points) and the mean total score was 3.8 points (2–6 points). Three feet in two patients were treated with Ponseti casting only (5 %) and did not need a percutaneous achilles tenotomy (pAT) or open release surgery. Fifty-two feet in 33 patients (88 %) were successfully treated with Ponseti casting and pAT. Four cases in two patients had to undergo a McKay Simons procedure (7 %). Thereby 93% of all cases were treated without open release surgery. Mean follow-up after the last cast was 7.4 months (3–16 months). A recurrence was seen in one patient representing two cases after about 8 months after pAT. The parents were non compliant with the abduction bar protocol and could not be convinced of the importance of the orthosis; a McKay Simons procedure was performed. No other cases of recurrence were observed during the follow up period. Discussion: The Ponseti method should be applied as originally described, and especially, if more people are involved in the treatment, a standard treatment regime is desirable. As the compliance of the parents is a crucial factor, everything should be done to ensure that the treatment is made as easy for them as possible. Only if a full support for questions or problems with the casts and especially with the braces is available, a good compliance can be ensured. The minimal invasive approach utilized by the percutaneous tenotomy is the lead argument in favor of the Ponseti method. In cases of recurrence or residual deformity when open surgery is necessary, this secondary procedure is in fact primary surgery. Thereby the danger of massive scaring associated with limited range of motion, pain and disability after a second procedures is prevented

Introduction: Clubfoot occurs in approximately 1 in 1,000 live births and is one of the most common congenital birth defects. Although there are multiple reports of successful treatment of idiopathic clubfeet with the Ponseti method, the use of this treatment in nonidiopathic clubfeet has not been reported. This purpose of this study was to evaluate early results of the Ponseti method for the treatment of clubfeet associated with distal arthrogryposis. Methods: Twelve consecutive infants with clubfoot (twenty-four clubfeet) associated with distal arthrogryposis were treated with the Ponseti method and retrospectively reviewed. Four patients had casting treatment prior to referral. The severity of the foot deformity was classified according to the grading system of Dimeglio. The number of casts required to achieve correction was compared to published data for idiopathic clubfeet. Any recurrent clubfoot deformities or complications during treatment were recorded. All patients were followed for a minimum of two years. Results: The clubfeet of all twelve patients (twentyfour clubfeet) were graded as Dimeglio grade IV. Initial correction was achieved in all patients with a mean of 6.75 ± 0.86 casts (range, two to ten casts), which was significantly more compared to the number needed in a published cohort of idiopathic clubfeet treated with the Ponseti method (p< 0.003). Three patients (six clubfeet) had a relapse after initial successful treatment. All relapses were related to non-compliance with brace wear. No relapses occurred in the cohort of patients who were initially treated with the new dynamic foot abduction orthosis (eight patients). Two of the three patients with clubfoot relapse were successfully treated with repeat castings and/or tenotomy; the remaining patient (two clubfeet) was treated with extensive soft-tissue release surgery. Conclusion: Our data supports the use of the Ponseti method in patients with distal arthrogryposis based on success rates approaching that for idiopathic clubfoot. Maintaining correction is perhaps the most difficult aspect of management. Parental teaching and early attention to brace complications are helpful techniques to improve parental compliance

The Pirani scoring system, together with the Ponseti method of club foot management, was assessed for its predictive value. The data on 70 idiopathic club feet successfully treated by the Ponseti method and scored by Pirani’s system between February 2002 and May 2004 were analysed. There was a significant positive correlation between the initial Pirani score and number of casts required to correct the deformity. A foot scoring 4 or more is likely to require at least four casts, and one scoring less than 4 will require three or fewer. A foot with a hindfoot score of 2.5 or 3 has a 72% chance of requiring a tenotomy. The Pirani scoring system is reliable, quick, and easy to use, and provides a good forecast about the likely treatment for an individual foot but a low score does not exclude the possibility that a tenotomy may be required

A less invasive surgical treatment of clubfoot is increasingly considered, it aims to limit extensive exposure, to improve the functional and cosmetic outcome and to lower the risk of stiffness and recurrence of the deformity. The Ponseti method consists in an original casting technique followed, only in the most resistant clubfeet, by a percutaneous Achilles tenotomy. Critical decision is the selection of the clubfeet which needs tenotomy. Purpose of this study was to determine if ultrasound assessment of clubfoot may be helpful in making surgical decision. MATERIAL AND Methods: 98 newborns with 122 congenital clubfeet were treated by the Ponseti casting technique from mid-2000 to June 2006. According to Manes classification, there were 20 mild, 47 moderate and 55 severe clubfeet. After 3 to 8 weeks of casting, clubfeet candidate to surgery underwent sonographic assessment according to the original technique previously published by the authors. On the sagittal posterior plane the R.O.M. of the ankle and subtalar joints was stated both in neutral position and under manipulation. No surgery was performed in clubfeet with normal sonographic dorsiflexion, percutaneous tenotomy was done in clubfeet with mild limited sonographic dorsiflexion and more extensive posterior release (tendon Z-lengthening and posterior cut of ankle and subtalar joint) was performed in clubfeet with most evident sonographic persistent equinus and anterior dislodgment of the talus in the ankle mortise. The R.O.M. was checked again by ultrasound at the end of treatment. According to Ponseti method a Denis Browne bar, with clubfoot 60° externally rotated, was worn full time until the walking age. Results: 35/122 clubfeet (28,6%) were treated conservatively (all the 20 mild and 15/47 of moderate deformities), 87/122 (71,4%) surgically (32/47 of moderate deformities and all the 55 severe deformities). On the basis of the dynamic ultrasound evaluation 38 clubfeet underwent simple tenotomy and 49 ones underwent extensive posterior release. At the end of the casting normal dorsiflexion was documented by ultrasound in 72 (82,7%) of the operated feet. Conclusions: The need of surgery in the Ponseti casting technique shows a great variability in Literature. These controversial data are probably due not only to the different confidence in the Ponseti method, but also to the different criteria used in evaluating the correction obtained by casting. Ultrasound assessment of the deformity gives objective qualitative and quantitative information about the restoration of the physiological dorsiflexion and articular biomechanics. On the basis of this simple, non invasive and widely available procedure the surgeon can evaluate the effectiveness of the serial casting and may be able to establish and graduate the need of corrective surgery

We report our initial experience of using the Ponseti method for the treatment of congenital idiopathic club foot. Between November 2002 and November 2004 we treated 100 feet in 66 children by this method. The standard protocol described by Ponseti was used except that, when necessary, percutaneous tenotomy of tendo Achillis were performed under general anaesthesia in the operating theatre and not under local anaesthesia in the out-patient department. The Pirani score was used for assessment and the mean follow-up time was 18 months (6 to 30). The results were also assessed in terms of the number of casts applied, the need for tenotomy of tendo Achillis and recurrence of the deformity. Tenotomy was required in 85 of the 100 feet. There was a failure to respond to the initial regimen in four feet which then required extensive soft-tissue release. Of the 96 feet which responded to initial casting, 31 (32%) had a recurrence, 16 of which were successfully treated by repeat casting and/or tenotomy and/or transfer of the tendon of tibialis anterior. The remaining 15 required extensive soft-tissue release. Poor compliance with the foot-abduction orthoses (Denis Browne splint) was thought to be the main cause of failure in these patients

The Ponseti method of clubfoot management requires a period of bracing in order to maintain correction. This study compared the effectiveness of ankle foot orthoses and Denis Browne boots and bar in the prevention of recurrence following successful initial management. Between 2001 and 2003, 45 children (69 feet) with idiopathic clubfeet achieved full correction following Ponseti casting with or without a tenotomy, of whom 17 (30 clubfeet) were braced with an ankle foot orthosis while 28 (39 clubfeet) were prescribed with Denis Browne boots and bar. The groups were similar in age, gender, number of casts and tenotomy rates. The mean follow-up was 60 months (50 to 72) in the ankle foot orthosis group and 47 months (36 to 60) in the group with boots and bars. Recurrence requiring additional treatment occurred in 25 of 30 (83%) of the ankle foot orthosis group and 12 of 39 (31%) of the group with boots and bars (p < 0.001). Additional procedures included repeat tenotomy (four in the ankle foot orthosis group and five in the group treated with boot and bars), limited posterior release with or without tendon transfers (seven in the ankle foot orthosis group and two in the group treated with boots and bars), posteromedial releases (nine in the orthosis group) and midfoot osteotomies (five in the orthosis group, p < 0.001). Following initial correction by the Ponseti method, children managed with boots and bars had far fewer recurrences than those managed with ankle foot orthoses. Foot abduction appears to be important to maintain correction of clubfeet treated by the Ponseti method, and this cannot be achieved with an ankle foot orthosis

Objective: The Ponseti method for the treatment of club foot has been shown to be effective in children up to one year of age. However, it is not known whether it is successful in older children. In this prospective study, we used Ponseti method in club foot after walking age; that are neglected or undergone an insufficient previous treatment. Materials and Methods: From 2003 to 2005 we treated and followed-up 37 feet of 30 patients. All the club foot deformities corrected by the method described by Ponseti, with minor modifications. The mean age at presentation was 21 months (12–72 months) and the mean follow-up was 26 months (16–32 months). 21 feet had previous conservative and surgical treatments. The mean applied cast count that used for this method was 5.4 (4 – 8 cast). After cast treatment we performed achilotomyfor 15 feet, achiloplasty for 20 feet and achiloplasty and posterior capsulotomy for 2 feet. All the patients evaluated before and after treatment by the Dimeglio classification. Results: Before treatment 35 feet were grade 3 and 2 feet were grade 4, and after the treatment 11 feet were grade 0, 26 feet were grade 1. All the patients deformities were corrected and the treatment results were statically significant (p=0.0001). Patients distincted in two groups according to their age at the beginning of the treatment. 20 feet were younger than 20 months and 17 feet were older than 20 months. All the patients younger than 20 months had grade 3 deformity before treatment and 19 feet improved grade 1 and 1 foot improved to grade 2 after this method. In patients older than 20 months 15 feet were grade 3 and 2 feet were grade 4. and after this treatment method in this group 13 feet were improved to grade 1 and 4 feet were improved to grade 2. Patients older than 20 months had worse results for the components of varus, medial rotation of calcanopedal block and adductus thant the other group. And difference in these groups were significant. (p> 0.005). Conclusion: We conclude that the Ponseti method is a safe, effective and low-cost treatment for idiopathic club foot presenting after walking age

The Ponseti method has been proven to be the gold standard of treatment for clubfoot. The question however remains about the treatment of atypical and complex feet with this method. The Ponseti technique has been used to treat all clubfeet at the our institution for the past 10 years. We interviewed 70 patients (114 affected feet) ages 5–9 regarding the current state of their clubfoot using the 10 item Disease Specific Instrument (DSI) developed by Roye et al. Of these, 16 patients had a complex foot defined by a transverse medial crease. The DSI scores from all patients were transformed onto a 100 point scale and compared based on overall score as well as functional outcome and satisfaction. There was no significant difference in the overall scores with a mean of 76.43 (sd= 21.1) in patients who did not have a complex deformity compared to a mean of 79.17 (sd= 19.4) in those who did have a complex foot (p=0.644). On the functional subscale the mean scores were 74.07 (sd=27.1) and 89.58 (sd=25.9) for patients who had non-complex and complex feet, respectively (p=0.474). Regarding satisfaction, the non-complex group had a mean score of 79.51 (sd=19.7) compared to the mean of 78.75 (sd=16.7) in the complex group (p=0.888). Primary treatment with the Ponseti method achieves very successful correction of the clubfoot deformity with good outcome scores. Furthermore, even in patients with a complex deformity, the Ponseti method still achieves equally successful outcomes

The purpose of the present study is to evaluate the early results of the Ponseti method when used for the treatment of idiopathic clubfoot among the population of the island of Crete. Fourteen consecutive infants (twenty-one feet) with idiopathic clubfoot deformity were managed with the Ponseti method and were retrospectively reviewed at a minimum of six months. The severity of the foot deformity was classified according to the grading system of Pirani et al. The number of casts required to achieve correction was compared with published data for the treatment of idiopathic clubfoot. Recurrent clubfoot deformities or complications during treatment were recorded. Initial correction was achieved with a mean of 5.2 casts. Tenotomy and Dennis-Browne braces followed the cast applications. One foot had a relapse which was then treated by a repeat tenotomy at the age of 8 months. Two children abandoned the protocol because the parents could not comply with bracing. No extensive surgery is needed so far and all feet are flexible and pain free. X-rays when taken showed the talo-calac-neal angle within normal limits. We support the use of the Ponseti method for the treatment of idiopathic clubfoot, since it can deliver flexible physiological feet, in the outpatient environment, thus avoiding the consequences of extensive open surgery

Purpose: To evaluate the effectiveness of the Ponseti method of the treatment i late presentation of clubfeet. Method: Prospective study comprising 91 patients(141 feet) between August 2003 and September 2005. Age range was from 7 dats to 20 months. Majority of patients belonged to Dimeglio grade 3 (75%) and Pirani grade 4(43%) at presentation. All were treated by Ponseti method of serial casting with or wothout tendo-achillis lengthening. Tendon lengthening was required in 79% of patients. The average duration of follow up was 1.5 years. Results: Recurrence of deformity was seen in patients who presented late and had severe deformity at time of presentation. The Ponseti technique failed to achieve correction in 4 patients. Follow up at 2 years showed overall correction rate of 95%. In develpoing countries, delayed presentation could signifucantly affect the final outcomes as the joint deformities progressively become fixed. Our study showed that number of corrective casts, recurrence of deformity and the nned for tendoachillis lengthening was inversly related to the time of presentation. This technique can be relable used to correct clubfeet even in delayed present

Introduction. It has been postulated that a mild clubfoot does better than a severe clubfoot no matter what treatment course is taken. There have been previous efforts to classify clubfoot. For units worldwide that use the Ponseti Method of clubfoot management, the Pirani scoring system is widely used. This scoring system has previously been shown to predict the number of plasters required to gain correction. Our study aimed to investigate whether the Pirani score gave an indication of longer-term outcome using tibialis anterior tendon transfer as an endpoint. Methods. A prospectively collated database was used to identify all patients treated in the Ponseti clinic at the Royal Manchester Children's Hospital between 2002 and 2005 with idiopathic clubfoot who had not received any treatment prior to their referral. Rate of tibialis tendon transfer as well as the patient's presenting Pirani score were noted. Feet were grouped for analytical purposes into a mild clubfoot (Pirani score <4) and a severe clubfoot (Pirani score 4) category depending on initial examination. Clinic records were reviewed retrospectively to identify patients who were poorly compliant at wearing boots and bars and were categorised into having “good” or “bad” compliance with orthosis use. Results. 132 feet in 94 children were included in the study. 30 (23%) tibialis tendon transfers were performed at a mean of 4.2 years (range 2.3–5.5 years). Children with severe clubfoot had a significantly higher rate of tendon transfer compared with those with mild clubfoot (28% vs. 6%; p=0.0001). 81% of patients were classified as being “good” boot wearers. Tibialis tendon transfer rates in those who were poorly compliant with boot usage were significantly higher compared with those with good compliance (52% vs. 16%; p=0.0003). There was a significantly higher tendon transfer rate in those with severe disease and poor compliance compared with good compliance (69% vs. 20%; p=0.0002). There was no association between boot compliance and tendon transfer rates in those with mild disease. Conclusion. This study shows that late recurrences, requiring tibialis anterior tendon transfer, are associated with severity of disease at presentation and compliance with use of orthoses. Tendon transfer rates are higher for those with severe disease. We have confirmed previous reports that compliance with orthotic use is associated with recurrence. However, the novel findings regarding recurrence rates in mild clubfeet may have implications regarding usage of orthoses in the management of mild idiopathic clubfeet after initial manipulation using the Ponseti method

Purpose: The aim of this study is to analyze objectively pathoanatomical changes of clubfoot treated with Ponseti method. Introduction: In the treatment of clubfoot, regardless of the grade and severity of the disease, first conservative treatment and serial casting should be chosen. The follow up period for surgery performed group ranges usually from 2 to 8 years (not longer than 10–15 years). Thirty years results of Ponseti’s idiopathic clubfoot treatment is with 78% success. In some recent series 95% success rate was reported. Standard conservative treatment (Kite’s) success rates are only 11% to 58% for idiopathic group. Material and Methods: Seventy patients, 115 feet (45 Bilateral, F/M 15/55) were included in the study. 28 of these patients were neurogenic group (20 Spina Bifida and 8 Artrogripotic). Since 1997, we strove Ponseti’s strict casting protocol. Bensahel’s a la carte PMR surgery was performed in 2 cases. Downey’s MRI evaluation criterias were used. In statistical analysis of the idiopathic, neurogenic and normal groups, ANOVA test was used. Results: The Navicular angle assessment was statistically significant (p< 0.05). Assessment of the results of idiopathic group was in normal range. Pathological components of Clubfoot were significantly reduced in the neurogenic group. Conclusions: Ponseti method is the effective treatment way of both the idiopathic clubfoot and the neurogenic foot. It is concluded that sound understanding of the anatomy of the foot, the biological response of young connective tissue and bone to changes in direction of mechanical stimuli, can gradually reduce or almost eliminate these deformities in most clubfeet

Non-operative treatment methods of idiopathic clubfoot have become increasingly accepted worldwide as the initial standard of care. The Ponseti method has become particularly popular due to published short and long term success rates in North America. The purpose of the current study was to examine the early rate of relapse in a New Zealand population and analyze patient characteristics for factors predictive of relapse. Fifty-one consecutive babies with seventy-eight club-feet treated by the Ponseti technique were followed prospectively for a minimum of two years from the start of treatment. Recurrence, defined as the need for any operative intervention, was analyzed with respect to severity at presentation, timing of presentation, the number of casts needed to obtain correction, family history of clubfoot, ethnicity, and compliance with abduction bracing. Recurrence was subdivided into minor recurrences, defined as a tendon transfer or Achilles lengthening, and major recurrences, defined as a full posterior or posteromedial release. Twenty patients (39%) had a recurrence. Eleven patients (22%) had a major recurrence and nine patients (17%) had a minor recurrence. Only three of twenty-five patients (12%) who were compliant with bracing had a major recurrence. Twenty-five of fifty-one patients (49%) were compliant with bracing. The greatest risk factor for recurrence was non compliance with abduction bracing, with an odds ration of 5 (p = 0.009). Although not quite statistically significant (p = .07), ethnicity was also related to recurrence, with Polynesian patients being three times less likely than white Europeans to recur. No statistically significant relationships were found between recurrence and severity at presentation, timing of presentation, the number of casts needed to obtain correction, or family history of clubfoot. Compliance with abduction bracing is crucial to avoiding recurrence of clubfoot. The Polynesian club-foot seems more amenable to Ponseti technique and less likely to recur than the white European clubfoot. In those patients who are compliant, the Ponseti method is very effective at maintaining a correction, with minimal need for major surgery. However, even among the compliant patients, minor recurrences are common, and among the noncompliant patients, many major and minor recurrences should be expected