Hexapod-Assisted Clubfoot Correction Strictly Following Ponseti Principles: A Purely Biomechanical Approach

BackgroundResistant, syndromic, and neuropathic clubfoot deformities may not respond to repeat Ponseti casting, leaving limited options short of extensive soft-tissue release or osteotomies. Hexapod-assisted gradual correction offers a multiplanar alternative, but existing approaches often diverge from Ponseti biomechanics.PurposeTo evaluate the feasibility and early outcomes of a hexapod correction protocol intentionally modeled after Ponseti principles in children with resistant, syndromic, or neuropathic clubfoot deformities.MethodsA retrospective, IRB-exempt review included 5 boys (mean age 7.4 ± 1.1 years) treated using a staged hexapod protocol replicating the Ponseti CAVE sequence. Diagnoses included arthrogryposis (n = 2), Muscular dystrophy (n = 1), and neuropathic clubfoot associated with spina bifida (n = 2). International Clubfoot Study Group (ICFSG) numeric scores were reconstructed retrospectively from clinical documentation. Minimum follow-up was 24 months.ResultsMean pretreatment ICFSG score was 40.6 (range 36-45), improving to 8.0 (range 4-14). Three patients achieved excellent outcomes (0-5), and 2 achieved good outcomes (6-15). All patients attained durable plantigrade alignment, and both neuropathic ulcers healed. Complications included 2 superficial pin-site infections and one reducible first MTP dislocation.ConclusionA Ponseti-guided hexapod strategy appears feasible for correcting severe, resistant, or syndromic clubfoot when casting is no longer viable. Reconstructed ICFSG scores demonstrated consistent improvement, though these early findings should be interpreted cautiously. Larger prospective studies are needed to clarify long-term durability and indications.Level of evidenceIV.