title: Correction of arthrogrypotic clubfoot with a modified Ponseti technique.
abstract: Surgical releases for arthrogrypotic clubfeet have high recurrence rates, require further surgery, and result in short, painful feet. We asked whether a modified Ponseti technique could achieve plantigrade, braceable feet. Ten patients (mean age, 16.2 months; range, 3-40 months), with 19 arthrogrypotic clubfeet, underwent an initial percutaneous Achilles tenotomy to unlock the calcaneus from the posterior tibia followed by weekly Ponseti-style casts. A second percutaneous Achilles tenotomy was performed in 53%. Mean number of casts was 7.7 (range, 4-12). From pretreatment to completion of initial series of casts, mean scores of Dimeglio et al. improved from 16 to 5 (ranges, 12-18 and 2-9, respectively), Catterall scores (as modified by Pirani and colleagues) from 4.8 to 0.9 (ranges, 1.5-6.0 and 0.0-2.0), and maximum passive dorsiflexion from -45 degrees (range, -75 degrees to -20 degrees ) to 10 degrees (range, 0 degrees to 40 degrees ). Ankle-foot orthoses maintained correction. At the minimum followup of 13 months (mean, 38.5 months; range, 13-70 months), the mean maximum dorsiflexion was 5 degrees (range, -20 degrees to 20 degrees ), two patients had posterior releases and no patient's ambulatory ability was compromised by foot shape. Arthrogrypotic clubfeet can be corrected without extensive surgery during infancy or early childhood. Limited surgery may be required as the children age.
authors.affiliation: Pediatric Orthopaedic Surgery, Shriners Hospital for Children-Philadelphia, 3551 North Broad Street, Philadelphia, PA 19140, USA. HvanBosse@shrinenet.org
authors.forename: Harold J P
authors.initials: HJ
authors.lastname: van Bosse
authors.forename: Salih
authors.initials: S
authors.lastname: Marangoz
authors.forename: Wallace B
authors.initials: WB
authors.lastname: Lehman
authors.forename: Debra A
authors.initials: DA
authors.lastname: Sala
mesh_terms: D000125:Achilles Tendon / Q000601:surgery*; D001176:Arthrogryposis / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D001696:Biomechanical Phenomena; D001915:Braces; D002370:Casts, Surgical; D002675:Child, Preschool; D003025:Clubfoot / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D003131:Combined Modality Therapy; D006801:Humans; D007223:Infant; D026201:Musculoskeletal Manipulations; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013709:Tendon Transfer; D013997:Time Factors; D016896:Treatment Outcome; D016138:Walking