title: Treatment results of late-relapsing idiopathic clubfoot previously treated with the Ponseti method.
abstract: BACKGROUND
  Idiopathic clubfoot has a stubborn tendency for relapse, with most relapses happening within the first few years. However, a few patients relapse later, adding to the complexity of management. This study investigates the treatment results of relapsing clubfoot deformity after age 4.
  
  
  METHODS
  Thirty-nine patients (60 feet) met the inclusion criteria. Age at initial treatment, previous treatment, number of casts and tenotomies, length of bracewear, and relapse presentation were recorded. Treatment of late relapse followed 1 of the 5 courses: (1) observation only (4 feet); (2) bracing (26 feet); (3) casting followed by bracing (7 feet); (4) casting followed by tibialis anterior tendon transfer (TATT) with or without open tendo Achilles lengthening (TAL) (8 feet); or (5) primary TATT±TAL (15 feet). Of the 37 feet treated initially with observation, bracing, or casting, 33 went on to have TATT (89%). Multiple other concurrent procedures were performed according to the specific deformities. These included plantar fasciotomy (6 feet), extensor hallicus longus recession (5 feet), limited posterior release 5 feet, and others (3 feet). Five feet underwent revision surgery after TATT, 2 of which ended in triple arthrodeses.
  
  
  RESULTS
  Average age at final follow-up was 23.3 years (range, 8.5 to 50.6 y). Ninety percent of patients wore regular shoes, 41% had pain with activities, but only 18% were limited in function by their feet. Average ankle dorsiflexion was 6 degrees (range, -15 to 25 degrees). Mild residual deformities were noted in 55% of feet.
  
  
  CONCLUSIONS
  This challenging group of patients with apparently persistent deforming biology achieves acceptable results with individualized evaluation and treatment of their foot deformities.
  
  
  METHODS
  Therapeutic level IV.
authors.affiliation: The Ponseti Center for Clubfoot Treatment, University of Iowa, Iowa City, IA, USA. sdmckay@texaschildrens.org
authors.forename: Scott D
authors.initials: SD
authors.lastname: McKay
authors.forename: Lori A
authors.initials: LA
authors.lastname: Dolan
authors.forename: Jose A
authors.initials: JA
authors.lastname: Morcuende
mesh_terms: D000125:Achilles Tendon / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000843:Ankle Joint / Q000502:physiology; D001915:Braces; D002370:Casts, Surgical; D002648:Child; D002675:Child, Preschool; D003025:Clubfoot / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult