title: Predictive factors for residual equinovarus deformity following Ponseti treatment and percutaneous Achilles tenotomy for idiopathic clubfoot: a retrospective review of 50 cases followed for median 2 years.
abstract: OBJECTIVE
  There is no consensus on how to predict residual equinovarus deformities after application of the Ponseti method. We assessed the prognostic value of clinical scoring systems, and also radiographic parameters that can be measured just before percutaneous Achilles tenotomy (PAT).
  
  
  METHODS
  We reviewed 50 cases of clubfoot in 35 patients who were treated using the Ponseti method, including PAT, to analyze the factors that are predictive of residual equinovarus deformities. Mean age at the time of PAT was 2.4 (1.4-3.5) months, and the mean follow-up period was 23 (9-61) months. We divided these cases into 2 groups according to the need for further surgery to treat the residual deformities.
  
  
  RESULTS
  40 feet with satisfactory results were included in group 1, whereas the remaining 10 feet that required further surgery for unsatisfactory residual deformities were included in group 2. We compared the initial Dimeglio and Pirani scores obtained before the first Ponseti casting, follow-up Pirani scores, and radiographic parameters determined just before PAT between these 2 groups. There was no statistically significant difference between the groups in terms of the initial Dimeglio and Pirani scores, although the follow-up Pirani scores and lateral tibiocalcaneal angle were higher and the lateral talocalcaneal angle was lower in group 2 at the time of PAT.
  
  
  CONCLUSIONS
  We conclude that the Pirani score, lateral tibiocalcaneal angle, and talocalcaneal angle, when assessed immediately before PAT, might be predictive factors for residual equinovarus deformity following Ponseti treatment for severe idiopathic clubfoot.
authors.affiliation: Department of Orthopaedic Surgery, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Hyounmin
authors.initials: H
authors.lastname: Noh
authors.forename: Soo-Sung
authors.initials: SS
authors.lastname: Park
mesh_terms: D000125:Achilles Tendon / Q000601:surgery*; D002111:Calcaneus / Q000033:anatomy & histology; D003025:Clubfoot / Q000000981:diagnostic imaging / Q000601:surgery / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D011379:Prognosis; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D013380:Subtalar Joint / Q000033:anatomy & histology; D013628:Talus / Q000033:anatomy & histology; D058971:Tenotomy / Q000379:methods*; D013977:Tibia / Q000033:anatomy & histology