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Complex, atypical clubfoot: follow-up after up to 16 years reveals a high risk of relapse but good functional and radiological outcomes

  • Orthopaedic Surgery
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Abstract

Introduction

The treatment of complex atypical clubfoot poses many challenges. In this paper, we report on the course of complex clubfoot, primary correction using the modified Ponseti method and midterm outcomes. Special consideration is given to clinical and radiological changes in cases of relapse.

Materials and methods

Twenty-seven cases of complex, atypical, non-syndromic clubfoot were treated in 16 children between 2004 and 2012. Patient data, treatment data, functional outcomes and, in the relapse cohort, radiological findings were documented during the course of treatment. The radiological findings were correlated with the functional outcomes.

Results

All atypical complex clubfeet could be corrected using a modified form of the Ponseti method. Over an average study period of 11.6 years, 66.6% (n = 18) of clubfeet relapsed. Correction after relapse showed an average dorsiflexion of 11.3° during a 5-years’ follow-up period. Radiological results showed residual clubfoot pathologies such as a medialized navicular bone in four clubfeet. There were no instances of subluxation or dislocation of the talonavicular joint. Extensive release surgery was not necessary. Nevertheless, after 2.5 preoperative casts (1–5 casts), bone correction was performed in n = 3 feet in addition to Achilles tendon lengthening and tibialis anterior tendon transfer.

Conclusion

Good primary correction of complex clubfoot using the modified Ponseti technique results in a high recurrence rate in the medium term. Relapse treatment without peritalar arthrolysis procedures produces good functional results even though minor residual radiological pathologies did persist in a minor number of cases.

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Data availability

All data presented or analysed during this study are included in this published article.

References

  1. Radler C, Mindler GT, Riedl K, Lipowski C, Kranzl A (2013) Midterm results of the Ponseti method in the treatment of congenital clubfoot. Int Orthop 13(37):1827–1831

    Article  Google Scholar 

  2. Bor N, Coplan JA, Herzenberg J, Ponseti I (2009) Treatment for idiopathic clubfoot: minimum 5-years follow-up. Clin Orthop Relat Res 467:1263–1270

    Article  PubMed  PubMed Central  Google Scholar 

  3. Church C, McGowan A, Henley J, Donohoe M, Niiler T, Shrader MW, Nichols LR (2020) The 5 years outcome of the Ponseti method in children with idiopathic clubfoot and arthrogryposis. J Ped Orthop 40:641–646

    Article  Google Scholar 

  4. Carpiaux AM, Hosseinzadeh P, Muchow RD, Iwinski HJ, Walker JL, Milbrandt TA (2016) The effectiveness of the Ponseti method for treating clubfoot associated with amniotic band syndrome. J Ped Orthop 36:284–288

    Article  Google Scholar 

  5. Matar HE, Beirne P, Garg NK (2017) Effectiveness of the Ponseti method for treating clubfoot associated with myelomeningocele: 3–9 years follow-up. J Ped Orthop B 26:133–136

    Article  Google Scholar 

  6. Eberhardt O, Langendörfer M, Fernandez FF, Wirth T (2012) Clubfoot associated with tibial and fibular hemimelia. Z Orthop Unfall 150:525–532

    CAS  PubMed  Google Scholar 

  7. Ponseti IV, Zhivkov M, Davis N, Sinclair M, Dobbs MB, Morcuende JA (2006) Treatment of the complex idiopathic clubfoot. Clin Orthop Rel Res 451:171–176

    Article  Google Scholar 

  8. Turco VJ (1994) Recognition and management of the atypical clubfoot. In: Simons GW (ed) The clubfoot: the present and a view of the future. Springer, New York, pp 76–77

    Chapter  Google Scholar 

  9. Kite JH (1964) The clubfoot. Grune & Stratton, New York

    Google Scholar 

  10. Dragoni M, Gabrielli A, Farsetti P, Bellini D, Maglione P, Ippolito E (2018) Complex iatrogenic clubfoot: is it a rare entity. J Ped Orthop B 27:428–434

    Article  Google Scholar 

  11. Eberhardt O, Peterlein CD, Fernandez F, Wirth T (2012) The Treatment of complex atypical clubfoot with the modified Ponseti method. OUP 12:212–217

    Google Scholar 

  12. Allende V, Paz M, Sanchez S, Lanfranchi L, Torres-Gomez A, Arana E, Nogueira MP, Masquijo JJ (2020) Complex clubfoot treatment with Ponseti method. A Latin America Multicentric Study. J Ped Orthop 40:241–245

    Article  Google Scholar 

  13. Duman S, Camurcu Y, Cobden A, Ucpunar H, Karahan N, Bursali A (2020) Clinical outcome of iatrogenic complex clubfoot treated with the modified Ponseti method. Int Orthop 44:1833–1840

    Article  PubMed  Google Scholar 

  14. Matar HE, Beirne P, Bruce CE, Garg N (2017) Treatment of complex idiopathic clubfoot using the modified Ponseti method: up to 11 years follow-up. J Ped Orthop B 26:137–142

    Article  Google Scholar 

  15. Bozkurt C, Sarikaya B, Sipahioglu S, Atay MA, Cetin BV (2021) Using the modified Ponseti method to treat complex clubfoot: early results. Jt Dis Realt Surg 32:170–176

    Google Scholar 

  16. Mandlecha P, Kanojja RK, Champawat SV, Kumar A (2019) Evaluation of modified Ponseti technique of complex clubfeet. J Clin Orthop Trauma 10:599–608

    Article  PubMed  Google Scholar 

  17. Ford-Powell VA, Barker S, Khan MS, Evans AM, Dietz FR (2013) The Bangladesh clubfoot project: the first 5000 feet. J Ped Orthop 33:40–44

    Article  Google Scholar 

  18. Zionts LE, Ebramzadeh E, Morgan RD, Sangiorgio SN (2018) Sixty years on: Ponseti method for clubfoot treatment produces high satisfaction despite inherent tendency to relapse. J Bone Jt Surg A 100:121–128

    Article  Google Scholar 

  19. Rastogi A, Agarwal A (2021) Long-term outcomes of the Ponseti method for treatment of clubfoot: a systematic review. Int Orthop 45:2599–2608

    Article  PubMed  Google Scholar 

  20. Simmons GW (1985) Complete subtalar release in clubfeet. Part II. Comparison of less extensive procedures. J Bone Jt Surg Am 67:1056–1065

    Article  Google Scholar 

  21. vanBosse HJP (2019) Challenging clubfeet: the arthrogrypotic clubfoot and the complex clubfoot. J Child Orthop 13:271–281

    Article  CAS  Google Scholar 

  22. Imhäuser G (1984) The treatment of idiopathic clubfoot. Enke Verlag, Stuttgart

    Google Scholar 

  23. Göksan SB, Bursali A, Bilgili F, Sivacioglu S, Ayanoglu S, Ponseti I (2006) Technique for the correction of idiopathic clubfeet presenting up to one year of age. Arch Orthop Trauma Surg 126:15–21

    Article  PubMed  Google Scholar 

  24. Al-Mohraj OA, Alshaalan FN, Alhussainan TS (2021) Is the modified Ponseti method effective in treating atypical and complex clubfoot? A systematic review. Int Orthop 45:2589–2597

    Article  Google Scholar 

  25. Johnson EJ, Fortney TA, Luk PC, Klein SE, McComick JJ, Dobbs MB, Gordon JE, Schoenecker PI (2020) Late effect of clubfoot deformity in adolescent and young adult whose initial treatment was an extensive soft-tissue release: topic review and clinical case series. JAAOS Glob Rel Res 4(e19):00126

    Google Scholar 

  26. Wei SY, Sullivan RJ, Davidson RS (2000) Talonavicular arthrodesis for residual midfoot deformities of a previously corrected clubfoot. Foot Ankle Int 21:482–485

    Article  CAS  PubMed  Google Scholar 

  27. Payan M, Otsuka NY (2010) Complications in the management of talipes equinovarus. In: McCarthy JJ, Drennan JC (eds) Drennan’s the child’s foot and ankle. Lipincott, Williams and Wilkins, Philadelphia

    Google Scholar 

  28. Aplington JP, Riddle CD (1976) Avascular necrosis of the body of the talus after combined medial and lateral release of congenital clubfoot. South Med J 69:1037–1038

    Article  CAS  PubMed  Google Scholar 

  29. Addosooki A, Tammam H, Morsy AF, Marzouq A, Ahmed EH, Ahmed AM, Said E (2021) Correlation of radiographic parameters with clinical correction in idiopathic congenital talipes equinovarus undergoing Ponseti treatment. Int Orthop 45:3139–3146

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Orthopaedic Department, Klinikum Stuttgart Olgahospital, Kriegsbergstrasse 62, 70174, Stuttgart, Germany

    Oliver Loose, Francisco Fernandez Fernandez, Micha Langendoerfer, Thomas Wirth & Oliver Eberhardt

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  1. Oliver Loose
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  2. Francisco Fernandez Fernandez
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  3. Micha Langendoerfer
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  4. Thomas Wirth
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  5. Oliver Eberhardt
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Correspondence to Oliver Eberhardt.

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Retrospective study using anonymous data.

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Loose, O., Fernandez Fernandez, F., Langendoerfer, M. et al. Complex, atypical clubfoot: follow-up after up to 16 years reveals a high risk of relapse but good functional and radiological outcomes. Arch Orthop Trauma Surg 143, 6097–6104 (2023). https://doi.org/10.1007/s00402-023-04840-y

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