title: Ponseti management of clubfoot after walking age.
abstract: BACKGROUND
  With an incidence of 1-2 per 1000 live births, clubfoot is one of the commonest congenital deformities. Deformity has four components: equinus, hindfoot varus, forefoot adductus, and cavus. The Ponseti method for the treatment of clubfoot has been shown to be effective in children up to one year of age. Even with this effective method, late-presenting cases are still challenging. The aim of this study is to evaluate the corrective effect of the Ponseti method on different components of clubfoot after walking age and to find how the patient's age relates to this correction.
  
  
  METHODS
  From 2003 to 2005 we treated 31 feet of 27 patients with clubfoot with a mean age of 21 months (12-72 months) with the Ponseti method. Average follow up was 42 months. All of the patients were evaluated before and after treatment for Dimeglio scores. Patients in the first group, aged less than 20 months, were compared with those in the second group, who were older than 20 months. The corrections for each component of the deformity were analyzed separately.
  
  
  RESULTS
  All deformities showed significant correction. Improvements for each separate component were found to be statistically significant. Patients older than 20 months improved less for the components of varus, medial rotation of calcaneopedal block and adductus compared to younger patients.
  
  
  CONCLUSIONS
  The Ponseti method is effective in correcting deformities of clubfoot, even after walking age, but affectivity may decrease with age.
authors.affiliation: Department of Orthopedics and Traumatology, Baltalimani Bone Diseases Hospital, Istanbul, Turkey. fyagmurlu@gmail.com
authors.forename: Mehmet Firat
authors.initials: MF
authors.lastname: Yagmurlu
authors.forename: Mehmet Nurullah
authors.initials: MN
authors.lastname: Ermis
authors.forename: Huseyin Emre
authors.initials: HE
authors.lastname: Akdeniz
authors.forename: Erkin
authors.initials: E
authors.lastname: Kesin
authors.forename: Eyup Selahattin
authors.initials: ES
authors.lastname: Karakas
mesh_terms: D000367:Age Factors; D002370:Casts, Surgical; D002675:Child, Preschool; D003025:Clubfoot / Q000628:therapy*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008349:Manipulation, Orthopedic / Q000295:instrumentation / Q000379:methods*; D011446:Prospective Studies; D016896:Treatment Outcome