Treatment of a recurrent clubfoot deformity after initial correction with the Ponseti technique

Early recognition and appropriate treatment of recurrent deformity (relapse) is an important component of the Ponseti technique of clubfoot correction. After correction of a clubfoot deformity by the Ponseti technique, relapse usually involves equinus and varus of the hindfoot. Cavus and adductus rarely recur to a clinically significant degree. Clubfoot recurs most frequently and quickly while the foot is rapidly growing-during the first several years of life. Recurrence of deformity will almost always occur, even after complete correction with the Ponseti technique, if appropriate bracing is not used. Treatment of clubfoot relapse in infants and toddlers is identical to the original correction maneuver. In a patient approximately 2.5 years of age, a relapse can be treated with anterior tibial tendon transfer to the third cuneiform with or without Achilles tendon lengthening. The indication for anterior tibial tendon transfer is the presence of dynamic supination during gait. After tendon transfer, bracing is no longer required because the eversion force of the transferred tendon maintains the correction. In a long-term follow-up study of patients treated by the Ponseti technique, the necessity for anterior tibial tendon transfer did not compromise the outcome with respect to level of pain and functional limitations. Because anterior tibial tendon transfer is joint sparing, the foot retains maximal strength and suppleness. Good long-term results can be anticipated despite clubfoot relapse.