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J Am Acad Orthop Surg. 2017 Mar;25(3):195-203. doi: 10.5435/JAAOS-D-15-00624.

Management of the Relapsed Clubfoot Following Treatment Using the Ponseti Method.

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From the Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO (Dr. Hosseinzadeh), the Department of Orthopaedic Surgery, University of Tennessee, and the Campbell Clinic, Memphis, TN (Dr. Kelly), and the Orthopaedic Institute for Children, David Geffen School of Medicine at the University of California, Los Angeles, Los Angeles, CA (Dr. Zionts).


The Ponseti method to treat idiopathic clubfoot deformity has proven to be reliable, and several centers have reported excellent outcomes. Although the method has been dependable in obtaining initial correction of the foot, relapse rates ranging from 26% to 48% have been reported. When a relapsed deformity is detected early, treatment with a short series of manipulations and cast applications followed by resumption of postcorrective bracing may be all that is required to regain and maintain correction. In patients aged >2.5 years, especially those who may be refractory to further brace use, deformity correction by preoperative cast treatment, followed by anterior tibial tendon transfer to the third cuneiform, is a good treatment option. Other procedures, such as combined cuboid-cuneiform osteotomy, posterior ankle and subtalar release, and, rarely, comprehensive posteromedial release or correction by gradual distraction, may be useful in select patients.

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