The Timing and Relevance of Relapsed Deformity in Patients With Idiopathic Clubfoot

Abstract

The development of a relapse affects the subsequent management and outcome of clubfoot deformity. The importance of bracing should be reinforced to parents. Bracing until at least age 4 years may be beneficial. For patients whose families are especially resistant to brace use and for older patients who experience a second relapse, regaining correction of the deformity via cast treatment followed by an Achilles lengthening procedure and/or tendon transfer may be the best alternative.

Using the modified Ponseti method to treat complex clubfoot: early results

“…Five of the patients had bilateral clubfeet, whereas six of the patients had unilateral clubfoot (two right and four left feet). A mean of 7 [5][6][7][8] casts were applied. After manipulation and casting, we performed Achilles tenotomies on all of the patients.…”

“…Ponseti et al [5], Matar et al [1], Dragoni et al [9], and Mandlecha et al [8] reported that to treat complex clubfoot, a mean number of 5 (range, 1-10), 7 (range, 5-10), 6 (range, 4-8), and 7.44 casts were required, respectively. We applied a mean number of 7 (range, [5][6][7][8] . In our study, we did not need any more casts after Achilles tenotomy because all ankle DF measurements exceeded 10°.…”

“…The Ponseti method frequently results in feet that are robust, flexible, and painless. Therefore, orthopaedic clinicians have used it more often, and it has become the gold standard treatment for clubfoot worldwide [2][3][4][5][6][7].…”

Bracing in clubfoot: Do we know enough?

“…Parental non-adherence with the use of FAB during the course of treatment is a problem that can affect 34% to 61% of children and results in five- to 17-fold higher odds of recurrence of the clubfoot deformity. 23-31…”

“…There is a strong correlation between both initial Dimeglio/Bensahel scores and the number of casts required for initial correction and risk for relapse and the need for future surgical intervention. 31,32 Initially stiffer feet should be followed with close attention, as they are more difficult to position correctly in the brace, being more likely to slip, causing blistering and irritability that consequently impacts overall bracing tolerance and adherence. 32…”