Identification and treatment of residual and relapsed idiopathic clubfoot in 88 children

Abstract

Background and purpose — The Ponseti treatment is successful in idiopathic clubfoot. However, approximately 11–48% of all clubfeet maintain residual deformities or relapse. Early treatment, which possibly reduces the necessity for additional surgery, requires early identification of these problematic clubfeet. We identify deformities of residual/relapsed clubfeet and the treatments applied to tackle these deformities in a large tertiary clubfoot treatment center.Patients and methods — Retrospective chart review of patients who visited our clinic between 2012 and 2015 focused on demographics, deformities of the residual/relapsed clubfoot, and applied treatment. Residual deformities were defined as deformities that were never fully corrected and needed additional treatment. We defined relapse as any deformity of the clubfoot reoccurring, after initial successful treatment, with necessity for additional treatment.Results — We identified 33 patients with residual and 55 patients with relapsed clubfeet. In both groups decreased dorsal flexion and adduction were the most often registered deformities. Furthermore, often equinus/decreased dorsiflexion, active supination, and varus occurred. In more than half, typical profiles of combined deformities were found. Relapses occurred at all stages of treatment and follow-up; half of the residual or relapsed clubfeet were identified before the end of the bracing period. In half of the patients, additional treatment consisted of the Ponseti treatment, one–quarter also required adaptation of the brace protocol, and one–quarter needed additional surgery. The Ponseti treatment was mainly reapplied if feet presented with relapses or residues until the age of 5.Interpretation — Practitioners should especially be aware of equinus/decreased dorsiflexion, adduction, and active supination as a sign of a residual or relapsed clubfoot. Due to the heterogeneous profiles of these clubfeet, treatment strategy should be based on a step-by step approach including recasting, bracing, and if necessary surgical intervention.

Clinical, Radiological, Pedobarographic, and Quality of Life Outcomes of the Ponseti Treatment for Clubfoot: A Prospective Study from Iran

“…Finally, the scores of the areas were added, and the lower the nal score, the better the quality of life [21]. g. Recurrence was de ned as the reappearance of one to all previous deformities after successful initial treatment [4].…”

“…Varieties of treatments are suggested for patients [7]. The standard and benchmark treatment strategy is the Ponseti method of management, which involves manipulation and weekly casting, percutaneous Achilles tenotomy in most patients, and maintenance of correction with braces for several years [4,8]. The rationale for using braces is that recurrence of clubfoot is common even after successful correction [9].…”

“…The prevalence of clubfoot in male infants is almost twice that of female ones [2]. It has a wide range of problems, depending on its severity, the treatment, and the success of that treatment [4,5].…”

What is the optimal treatment for equinus deformity in walking-age children with clubfoot? A systematic review

“…Stouten et al reported that isolated equinus deformity accounted for 40% of all observed relapses, with a further 36% displaying some element of equinus. 20 In a study assessing correlations between foot function and perceived disability, McCahill et al found that perceived disability was associated with equinus deformity, hindfoot deformity in coronal and sagittal planes, and medial forefoot pressure gait parameters. 21 Residual or recurrent deformity of the hindfoot causes significant disability.…”

Concomitant Talocalcaneal Coalition as a Risk Factor for Early Relapse Following Ponseti Treatment of Idiopathic Clubfoot

“…Early relapse is usually encountered within the first 2 years of successfully completing the Ponseti treatment [8][9][10][11][12] and responds relatively well to the repeated application of this method [9,10,13,14]. Late relapsed feet are frequently treated with various types of surgery; however, the Ponseti technique is still recommended as the first treatment irrespective of age or severity of the deformity.…”