Narrative review of the management of a relapsed clubfoot

Abstract

The management of idiopathic clubfoot has transformed over the past several decades as the Ponseti method for the correction of this deformity became the standard of care, and surgical release has almost all but been abandoned. The Ponseti method has shown very high initial success rate and excellent long-term functional results. Relapse of the deformity, however, continues to be a major problem, occurring in up to 40% of patient, and there is no consensus on the definition and management of the relapsed clubfoot. This review discusses the available management options for the treatment of a relapsed clubfoot deformity following initial treatment with the Ponseti method [including repeat casting, tendo-Achilles lengthening, plantar fascia release, and tibialis anterior tendon transfer (TATT)] as well as following initial surgical treatment with posteromedial release (including casting, hemiepiphysiodesis, revised posteromedial release, osteotomies, fusion, and the use of gradual distraction with external fixators). These are discussed from the least to the most invasive. Available evidence, and limitations of the literature, for the management of relapses following both the Ponseti method and initial surgical release is reviewed along with along with the reported outcomes. Future efforts should be geared towards standardizing the definition of a relapse with objective criteria for its management.

Factors associated with the relapse in Ponseti treated congenital clubfoot

“…This conservative method significantly reduces the complications of the extended surgery, such as stiffness and arthritis of the foot in adulthood. Previous studies reported relapse rates up to 40% [ 9 ]. However, a common question that is usually raised is, “What factors are associated with relapse?” This study analyzed a combination of clinical factors for their association with relapse after treatment with the Ponseti method.…”

“…However, relapses are common in severe clubfeet and are probably caused by the same pathology that initiated the deformity. The rate of recurrence after using the Ponseti method, occurring in up to 40% of patient [ 9 ]. The factors that relate to the recurrence are still debatable [ 10 ].…”

Club foot management in the Bafoussam Baptist Healthcare center (BBHC), Cameroon: Treatment outcomes and the associated factors of relapse with the Ponseti’s technique

“…Previous studies reported relapse rates of up to 40% [33]. However, a common question that is usually raised is, "What factors are associated with relapse?"…”

Outcomes of Eight‐Plate Epiphysiodesis for Residual Clubfoot Deformities

“…The physiopathology of forefoot adduction attributes to the imbalance between the elongated lateral column and shortened medial column of the midfoot. Hence many types of osteotomies have been attempted which require internal or external fixation and restricted weight bearing 10 , 11 , 12 , 13 , 14 . However, the bony deformity in children could also be corrected by manipulating the growth behavior of an open physis.…”

“…Among the deformities, residual forefoot adduction with supination after treatment is a common issue which is also referred to as the “bean‐shaped foot” 9 . To the best of our knowledge, the combination of a cuboid closing with a cuneiform opening wedge osteotomy or with a trans‐midfoot osteotomy is currently the most popular procedure to correct the residual forefoot adduction 10 , 11 , 12 , 13 , 14 . However, complications such as neurovascular lesion, non‐union or permanent foot stiffness might occur during the operation.…”