Background: Nonoperative treatment of idiopathic clubfoot has become
increasingly accepted worldwide as the initial standard of care. The Ponseti
method has become particularly popular as a result of published short and
long-term success rates in North America. The purpose of the current study was
to examine the early rate of clubfoot recurrence following the use of the
Ponseti treatment method in a New Zealand population and to analyze patient
characteristics to identify factors predictive of recurrence.
Methods: Fifty-one consecutive babies with a total of seventy-three
clubfeet treated by the Ponseti technique were followed prospectively for a
minimum of two years from the start of treatment. Recurrence, defined as the
need for any subsequent operative treatment, was analyzed with respect to the
severity at presentation, the time of presentation, the number of casts needed
to obtain the initial correction, any family history of clubfoot, ethnicity,
and the compliance with postcorrection abduction bracing. Recurrence was
classified as minor, defined as requiring a tendon transfer or an Achilles
tendon lengthening, or major, defined as requiring a full posterior or
posteromedial surgical release to achieve a corrected plantigrade foot.
Results: Twenty-one (41%) of the fifty-one patients had a
recurrence, which was major in twelve of them and minor in nine. The parents
of twenty-six babies (51%) complied with the abduction bracing protocol, and
only three of these children had a major recurrence. Compliance with abduction
bracing was associated with the greatest risk reduction for recurrence (odds
ratio, 0.2; p = 0.009). When the parents had not complied with the bracing
protocol, the patient had a five times greater chance of having a recurrence.
With the numbers studied, no significant relationships were found between
recurrence and the severity at presentation, the time of presentation, the
number of casts needed to obtain correction, ethnicity, or a family history of
Conclusions: Compliance with the postcorrection abduction bracing
protocol is crucial to avoid recurrence of a clubfoot deformity treated with
the Ponseti method. When the parents comply with the bracing protocol, the
Ponseti method is very effective at maintaining a correction, although minor
recurrences are still common. When the parents do not comply with the bracing
protocol, many major and minor recurrences should be expected.
Level of Evidence: Prognostic Level II. See Instructions
to Authors for a complete description of levels of evidence.