Treatment of Non-idiopathic, Neglected, and Recurrent Clubfoot After Surgery Using the Ponseti Method

Background The Ponseti technique is widely regarded as the most effective treatment for idiopathic clubfoot. However, the results obtained with this technique in non-idiopathic, neglected, and recurrent clubfoot remain controversial. Objective The objective of this study was to determine the effectiveness of the Ponseti technique in non-idiopathic clubfoot.  Materials and methods This was a prospective study including 39 patients (60 feet) with non-idiopathic clubfoot (26 cases; 41 feet), neglected idiopathic clubfoot (six cases; eight feet), and recurrent clubfoot after posteromedial release surgery (seven cases; 11 feet). Patients were evaluated at each cast session using the Pirani score. Correction followed the cavus-adductus-varus and equinus sequence. The number of casts, initial correction rate, treatment failure rate, and recurrence rate were recorded. The average follow-up period was 18 months (range, 12-30 months). Result The average age at the time of the first cast was 20 months, ranging from 14 days to nine years, with a male predominance, accounting for 74.3% of cases. The malformation was located on the left side in eight cases, on the right side in 10 cases, and was bilateral in 21 cases. The causes of secondary clubfoot were dominated by spina bifida in 11 cases and arthrogryposis in eight cases. The average number of casts was seven (range, 4-14 casts): seven casts (range, 5-11 casts) in neglected clubfoot, six casts (range, 4-8 casts) in recurrent clubfoot after surgery, and seven casts (range, 5-12 casts) in non-idiopathic clubfoot. Achilles tendon tenotomy or lengthening for recurrences was performed in all patients. Anterior tibial transfer was performed in four cases of persistent residual dynamic supination. In eight cases, Achilles tendon tenotomy was performed before correction of other deformities due to stagnation of the Pirani score. Four feet presented recurrence, of which two were operated on using a posteromedial approach, and the other two were reassessed using the Ponseti method, with satisfactory results. Two feet had a recurrence of equinus, which was managed by re-tenotomy of the Achilles tendon. Two cases benefited from shortening the external arch due to persistent residual adduction. Conclusion Treatment of non-idiopathic, neglected, and recurrent clubfoot after surgery requires more plaster cast sessions but remains a non-invasive method with satisfactory results.