Long-term outcomes of atypical clubfoot treated with the Ponseti method

Abstract

Introduction Congenital clubfoot is the most common congenital malformation of the foot in children. Despite the relatively low birth rate clubfoot shows no tendency to decrease in the population. On the contrary, there is an increased number of foot pathologies associated with central nervous system anomalies and other pathological syndromes. Atypical clubfoot according to Ponseti's classification requires early recognition and continues to challenge the skills of the pediatric orthopedic surgeon. The objective was to draw the attention of pediatric orthopedists on the problem of atypical clubfoot. The goals were to discuss common errors in the treatment of atypical clubfoot and assess a recurrence rate that would require a re-operation. Material and methods A total of 135 children (184 feet) with atypical clubfoot which amounted to 12.1 % of the total clubfoot cases were treated in hospitals of the city of Yaroslavl between May 2006 and December 2019. The review included 106 children (147 feet) with atypical clubfoot who could benefit from Ponseti treatment. The mean long-term followup period was 7.2 years. Results Relapses requiring re-operation occurred in 51 children (83 feet) that amounted to 48.1 % of the total atypical clubfoot cases treated in Yaroslavl. Discussion Appropriate bracing is an important component of the Ponseti technique of atypical clubfoot correction in everyday practice of the pediatric orthopedist. Untimely detection of atypical clubfoot and non-compliance with bracing protocol in typical clubfoot can result in an iatrogenic atypical clubfoot with likelihood of major reconstructions and poor prognosis. Conclusion The Ponseti method in Russia is the "gold standard" for the treatment of clubfoot.

Keywords

• atypical clubfoot
• iatrogenic clubfoot
• ponseti method
• recurrence