title: Is it possible to treat recurrent clubfoot with the Ponseti technique after posteromedial release?: a preliminary study.
abstract: The Ponseti technique for treating clubfoot has been popularized for idiopathic clubfoot and more recently several syndromic causes of clubfoot. We asked whether it could be used to treat recurrent clubfoot following failed posteromedial release. We retrospectively reviewed 58 children (83 clubfeet) treated by the Ponseti technique for recurrent deformity after posteromedial release in three centers. The minimum followup was 24 months (average, 45 months; range, 24-80 months). We determined initial and final Pirani scores and range of motion of the ankle and subtalar joint. Plantigrade and fully corrected feet were obtained in 71 feet (86%); 11 feet obtained partial correction; one patient failed treatment and underwent another posteromedial release. Recurrences occurred in nine patients (12 feet or 14%). Initial Pirani scores improved in all but one patient; severity of deformity was also inferred by number of casts used for treatment. The age at treatment and numbers of casts did not influence the scores of Pirani et al. The scores were similar among the three orthopaedic surgeons.
  
  
  METHODS
  Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
authors.affiliation: Pediatric Orthopaedic Group, Orthopaedics Department, Hospital do Servidor Público Estadual, São Paulo, Brazil. monipn@uol.com.br
authors.forename: Monica Paschoal
authors.initials: MP
authors.lastname: Nogueira
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Ey Batlle
authors.forename: Cristina Gomes
authors.initials: CG
authors.lastname: Alves
mesh_terms: D000125:Achilles Tendon / Q000601:surgery*; D000293:Adolescent; D000367:Age Factors; D000843:Ankle Joint / Q000503:physiopathology*; D001696:Biomechanical Phenomena; D001915:Braces; D001938:Brazil; D002370:Casts, Surgical; D002648:Child; D002675:Child, Preschool; D003025:Clubfoot / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D003131:Combined Modality Therapy; D005060:Europe; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D026201:Musculoskeletal Manipulations; D010865:Pilot Projects; D011859:Radiography; D016059:Range of Motion, Articular; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013380:Subtalar Joint / Q000503:physiopathology; D013709:Tendon Transfer; D016896:Treatment Outcome