Modified Ponseti method of management of neonatal club feet

The aim of this study was to assess the outcome of a new protocol for the management of neonatal clubfeet that can be considered as a modification of the Ponseti method. The modifications consisted of performing the tenotomy of the Achilles tendon prior to the application of the first cast and using only one cast for a period of 3 weeks following tenotomy. We applied the modified method in 50 children (82 club feet) and assessed the degree of deformity using the Pirani and the Dimeglio scoring systems. The minimum follow-up period was 28 months (range: 24-32). The intermediate range follow-up results of this study showed that the modified Ponseti method was associated with a good outcome in 85% of cases of neonatal club feet with a Pirani score of 5 or less and a Dimeglio score of 15 or less. Persistently high Pirani or Dimeglio scores immediately after tenotomy and poor compliance with splintage were predictors of failure of the modified technique.