Vishnu M.1, Jacob Mathew2, Raju Karuppal3, Amarnath Prasad4
BACKGROUND
Though the Ponseti method has become the popular and standard of care for
clubfoot correction, relapse of clubfoot deformity following correction is not
uncommon. The relapsed feet can progress from flexible to rigid if left untreated
and can become as severe as the initial deformity. The purpose of this study was
to analyse the relapse pattern in clubfeet that have undergone treatment with the
Ponseti method.
METHODS
Between 2015 and 2017, 78 children (134 feet), 58 boys and 20 girls were included
in this study. It was a prospective observational study of relapse patterns in
idiopathic clubfoot after one year of completion of the Ponseti method of
treatment. Pirani scoring system was used to identify the relapse.
RESULTS
Dynamic, fixed, and complete relapse patterns were observed in this study.
Patients were categorised into two groups - bilateral and unilateral. In the bilateral
group, 18 children (36 feet i.e. 23 %) had decreased ankle dorsiflexion, 5 had (10
feet i.e. 6 %) rigid equinus, 22 had (44 feet i.e., 29 %) dynamic forefoot adduction
or supination and 5 had (10 feet i.e. 6 %) fixed adduction in forefoot and midfoot.
Six children from the bilateral group showed complete relapse. Among the
unilateral group, 8 children (8 feet i.e. 36 %) presented with decreased ankle
dorsiflexion, 4 had (4 feet i.e. 18 %) rigid equinus relapse, 6 had (6 feet i.e. 27
%) dynamic forefoot adduction or supination and 4 had (4 feet i.e. 18 %) showed
fixed forefoot adduction.
CONCLUSIONS
Dynamic forefoot adduction or supination pattern is common to relapse pattern in
the bilateral group and dynamic hind-foot relapse was common in the unilateral
group. Age at initial presentation, initial Pirani score, and the number of casts
required were not significantly related to the incidence of relapse.
