Age of Recurrence in Idiopathic Clubfoot Treated with the Ponseti Method

While studies of patients undergoing the Ponseti method for idiopathic clubfoot demonstrate excellent correction after initial treatment, recurrence can occur in more than half of the cases. Few studies have demonstrated the age at which recurrence typically occurs or if age at discontinuation of the foot ankle orthosis (FAO) is associated with risk for surgical intervention.

Patients with idiopathic clubfoot treated with the Ponseti method with greater than 3 years of follow-up were evaluated. Age at presentation, need for percutaneous Achilles tenotomy, age of initiation of foot abduction orthosis, adherence with FAO, and need for additional treatment were recorded. Severity scores were recorded at initial presentation and yearly throughout follow-up.

110 patients were followed for an average of 5.9 years, and 32 patients required surgical intervention. Patients who eventually required surgery had significantly higher severity scores at presentation. Though they maintained higher scores throughout the follow-up period, they did not demonstrate significantly higher scores until 3 years of age. FAO was used until an average age of 2.6 years (range: 0.4 to 5.1 years). There was a significant difference in the age at which the FAO was stopped in those patients who eventually required surgery versus those who did not (2.2 years versus 2.8 years).

Patients with recurrence after initially successful Ponseti treatment generally do not become distinguishable by our current classification systems until 3 years of age. Patients who used the FAO for more than 2 years were 2.77 times less likely to require surgery than those who used it less than 2 years. FAO use should be continued until at least 3 years of age in patients undergoing Ponseti treatment for idiopathic clubfoot.