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

Abstract

Objectives In complex clubfoot, equinus, varus of the heel, forefoot adduction, and supination are more severe than in typical clubfoot. The feet are short and stubby, with deep creases above the heel and on the plantar surface. To successfully treat this subgroup of patients, orthopaedic clinicians must be able to recognise the clinical characteristics of complex clubfoot and implement the appropriate treatment effectively.Methods A total of 11 patients with 16 clubfeet were included in this study. Demographic features, clubfoot severity, number of casts, position of each foot before cast removal, ankle dorsiflexion (DF), complications, and additional procedures were noted at all clinical visits.Results The mean follow-up period was 13.3 months. All patients were initially corrected using a mean of 7 (5–8) casts and Achilles tenotomy. Relapses occurred in three patients (18.75%), but all recovered after recasting. The creases above the heels disappeared in all of the patients, whereas plantar creases persisted on two (12.5%) feet. The mean Pirani scores calculated at the first visit, after tenotomy, and at the final visit were 5.22± 0.52,, 0.72 ± 0.41and 0.41 ± 0.42, respectively. The mean DF measurements recorded before tenotomy, after tenotomy, and at the final visit were 8.31° ± 3.03°, 15.19° ± 3.75 °, and 20.19° ± 4.46°, respectively. Pirani scores and DF improved statistically significantly after treatment, and DF improved significantly between tenotomy and the final visit.Conclusions The modified Ponseti method is an effective treatment for complex clubfoot. It is crucial that orthopaedic clinicians can recognise this deformity at any stage and implement the modified Ponseti method effectively.