Ponseti method for management of neglected idiopathic clubfoot

Background Although the Ponseti method has been effective in early presented clubfoot, limited information is available on the use of this method in older patients. Methods We prospectively followed 20 children (30 feet) with neglected idiopathic clubfoot. We sought to determine whether initial correction of the deformity (a plantigrade foot) could be achieved using the Ponseti method in untreated idiopathic clubfeet in patients presenting between the ages of 12–36 months. Results Older children needed more casts than younger children. Twenty-one of 30 (70%) feet needed percutaneous tendo-Achilles tenotomy for residual equinus deformity. The mean dorsiflexion after removal of the last cast was 12.5°. Six feet relapsed (20%) and were treated with recasting and tibialis anterior transfer in four feet, and two feet needed limited medial release, tendo-Achilles tenotomy, abductor hallucis tenotomy, and tibialis anterior transfer. Conclusions The Ponseti technique was effective in treatment of neglected clubfoot in patients between the ages of 12–36 months.