Use of the Ponseti method for recurrent clubfoot following posteromedial release. 2008

Sumeet Garg, and Matthew B Dobbs
St Louis Children's Hospital, Shriners Hospital St Louis, MO 63110, USA.

BACKGROUND A child with recurrent or incompletely corrected clubfoot after previous extensive soft tissue release is treated frequently with revision surgery. This leads to further scarring, pain and limitations in range of motion. We have utilized the Ponseti method of manipulation and casting and when indicated, tibialis anterior tendon transfer, instead of revision surgery for these cases. METHODS A retrospective review of all children treated since 2002 (n = 11) at our institution for recurrent or incompletely corrected clubfoot after previous extensive soft tissue release was done. Clinical and operative records were reviewed to determine procedure performed. Ponseti manipulation and casting were done until the clubfoot deformity was passively corrected. Based on the residual equinus and dynamic deformity, heel cord lengthening or tenotomy and tibialis anterior transfer were then done. Clinical outcomes regarding pain, function and activity were reviewed. RESULTS Eleven children (17 feet) with ages ranging from 1.1 to 8.4 years were treated with this protocol. All were correctable with the Ponseti method with one to eight casts. Casts were applied until the only deformities remaining were either or both hindfoot equinus and dynamic supination. Nine feet required a heel cord procedure for equinus and 15 required tibialis anterior transfer for dynamic supination. Seven children have follow-up greater than one year (average 27.1 months) and have had excellent results. Two patients had persistent hindfoot valgus which required hemiepiphyseodesis of the distal medial tibia. CONCLUSIONS The Ponseti method, followed by tibialis anterior transfer and/or heel cord procedure when indicated, can be successfully used to correct recurrent clubfoot deformity in children treated with previous extensive soft tissue release. Early follow-up has shown correction without revision surgery. This treatment protocol prevents complications of stiffness, pain and difficulty in ambulating associated with multiple soft tissue releases for clubfeet.

UI MeSH Term Description Entries

Related Publications

Sumeet Garg, and Matthew B Dobbs
December 2018, Journal of children's orthopaedics,
Sumeet Garg, and Matthew B Dobbs
May 2009, Clinical orthopaedics and related research,
Sumeet Garg, and Matthew B Dobbs
January 2012, Journal of pediatric orthopedics. Part B,
Sumeet Garg, and Matthew B Dobbs
January 2015, Journal of pediatric orthopedics. Part B,
Sumeet Garg, and Matthew B Dobbs
August 2010, The Journal of the American Academy of Orthopaedic Surgeons,
Sumeet Garg, and Matthew B Dobbs
January 1986, Journal of pediatric orthopedics,
Sumeet Garg, and Matthew B Dobbs
January 2014, International orthopaedics,
Sumeet Garg, and Matthew B Dobbs
December 2016, Operative Orthopadie und Traumatologie,
Sumeet Garg, and Matthew B Dobbs
November 2014, World journal of orthopedics,
Copied contents to your clipboard!