Relapsing and Residual Clubfoot Deformities After the Application of the Ponseti Method:A Contemporary Review



1 Orthopedic Research Center, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran

2 Orthopedic Research Center, Ghaem Hospital


The Ponseti method is a safe and effective treatment for congenital clubfoot, and radically decreases the need for extensive corrective surgery. But a group of patients will still present with under corrected residual equinovarus deformities despite the proper use of the Ponseti method. About 25% of operated clubfeet will develop recurrence or show a marked residual deformity (recurrent clubfoot); however, in the recent literature, the failure rate of the Ponseti method, defined by the need for corrective surgery, ranges from 3% to 5%. Deformities encountered in patients with residual clubfeet comprise of various degrees of equinus, varus, adduction, supination, cavus, and toe deformity. Joint flexibility or stiffness, tarsal dysmorphism, articular incongruence, and progressive degrees of degeneration may be also present. We try to emphasize the current solutions for these deformities.


  1. Dobbs MB, Morcuende JA, Gurnett CA, Ponseti IV. Treatment of idiopathic clubfoot: an historical review. Iowa Orthop J. 2000; 20:59-64.

  2. Sambandam SN, Gul A. Stress radiography in the assessment of residual deformity in clubfoot following postero-medial soft tissue release. Int Orthop. 2006;30(3):210-4.

  3. Willis RB, Al-Hunaishel M, Guerra L, Kontio K. What proportion of patients need extensive surgery after failure of the Ponseti technique for clubfoot? Clin Orthop Relat Res. 2009;467(5):1294-7.

  4. Church C, Coplan JA, Poljak D, Thabet AM, Kowtharapu D, Lennon N, et al. A comprehensive outcome comparison of surgical and Ponseti clubfoot treatments with reference to pediatric norms. J Child Orthop. 2012;6(1):51-9.

  5. Noh H, Park SS.  Predictive factors for residual equinovarus deformity following Ponseti treatment and percutaneous Achilles tenotomy for idiopathic clubfoot. Acta Orthop. 2013;84(2):213-7.

  6. Changulani M, Garg NK, Rajagopal TS, Bass A, Nayagam SN, Sampath J, et al. Treatment of idiopathic club foot using the Ponseti method Initial experience. J Bone Joint Surg Br. 2006;88(10):1385-7.

  7. Delbrück H, Schaltenbrand M, Schröder S, Rauschmann M, Schwenninger C. Clubfoot treatment through the ages: the Ponseti method in comparison to other conservative approaches and operative procedures. Orthopade. 2013;42(6):427-33.

  8. Nordin S, Aidura M, Razak S, Faisham W. Contraversies in congenital clubfoot: Literature review. Malays J Med Sci. 2002;9(1):34-40.

  9. Loza ME, Bishay SN, El-Barbary HM, Hanna AA, Tarraf YN, Lotfy AA. Double column osteotomy for correction of residual adduction deformity in idiopathic clubfoot. Ann R Coll Surg Engl. 2010;92(8):673-9.

  10. Rathjen KE. Disorders of the foot. In: Herring JA ed. Tachdjian`s pediatric orthopaedics. 4th ed. Philadelphia: Elsevier; 2008: 1079-94.

  11. Lykissas MG, Crawford AH, Eismann EA, Tamai J. Ponseti method compared with soft-tissue release for the management of clubfoot: A meta-analysis study. World J Orthop. 2013;4(3):144-53.

  12. Otremski I, Salama R, Khermosh O, Wientroub S. Residual adduction of the forefoot a review of the Turco procedure for congenital clubfoot.J Bone Joint Surg Br. 1987;69(5):832-4.

  13. Mahadev A, Munajat I, Mansor A, Hui JH. Combined Lateral and Transcuneiform without Medial Osteotomy for Residual Clubfoot for Children. Clin Orthop Relat Res. 2009;467(5):1319-25.

  14. Park SS, Lee HS, Han SH, Park JW, de Peralta MJ. Gastrocsoleus fascial release for correction of equinus deformity in residual or relapsed clubfoot. Foot Ankle Int. 2012;33(12):1075-8.

  15. Al-Aubaidi Z, Lundgaard B, Pedersen NW. Anterior distal tibial epiphysiodesis for the treatment of recurrent equinus deformity after surgical treatment of clubfeet. J Pediatr Orthop. 2011;31(6):716-20.

  16. Ganger R, Radler C, Handlbauer A, Grill F. External fixation in clubfoot treatment - a review of the literature. J Pediatr Orthop B. 2012;21(1):52-8.