Relapse of Clubfoot after Treatment with the Ponseti Method and the Function of the Foot Abduction Orthosis

Ponseti clubfoot treatment has become more popular during the last decade because of its high initial correction rate. But the most common problem affecting the long-term successful outcome is relapse of the deformity. Non-compliance with Ponseti brace protocol is a major problem associated with relapse. Although more comfortable braces have been reported to improve the compliance, they all have the same design and no significant changes have been made to the protocols. After refinement in the Ponseti method and emphasizing the importance of brace to parents, the relapse rate has been markedly decreased. Nevertheless, there are patients who do not have any recurrence although they are not completely compliant with the brace treatment, whereas other patients have a recurrence even though they are strictly compliant with the brace treatment. The aim of this article is to review the relapse of clubfoot and the function of the brace and to develop an individualized brace protocol for each patient by analyzing the mechanism of the brace and the biomechanical properties of muscles, tendons, and ligaments.

Associations of intracompartmental leg pressures and radiographic findings in congenital talipes equinovarus.

The etiopathogenesis of congenital talipes equinovarus remains mysterious. The authors investigated the role of increased intracompartmental leg pressures as a causal relationship with this deformity by measuring the pressures in 25 children aged between 6 months and 1 year with unilateral talipes equinivarus before surgical release. The deep posterior intracompartmental pressure in the leg with talipes equinovarus was greater than the other compartments, and the deep and superficial posterior intracompartmental pressures were also significantly higher than those of the contralateral normal sides (p < 0.05). There were linear correlations between the posterior intracompartmental pressure of affected legs and the Kite index, tibiocalcaneal angle and talo-first metatarsal angle of the affected legs. Deep posterior intracompartmental pressure is a strong predictor of abnormality in the Kite index. The present study showed a probable causal relationship between increased deep posterior intracompartmental pressure and etiopathogenesis of talipes equinovarus.

Problems in surgical treatment of congenital clubfoot.

Twenty-three patients with 32 congenital rigid clubfeet treated by posteromedial release were reviewed after a follow-up averaging 33 months. The feet were assessed both clinically and radiologically; a satisfactory result was obtained in 17 feet inspite of residual deformity of forefoot adduction. Early operation and adequate postoperative immobilisation were major factors in contributing to a satisfactory result.