Dobbs and Gurnett (2009) review the etiology and treatment of congenital talipes equinovarus, covering what is known about genetic and environmental causation, the historical arc from forceful manipulation to extensive surgical release, and the evidence supporting the Ponseti method as current gold standard. The review addresses when and how surgery remains appropriate in the modern era.
When you see a newborn with clubfoot, start Ponseti casting within the first weeks of life, anticipate Achilles tenotomy in over 90% of cases, and counsel families that brace compliance for 4 years is the single most important factor in preventing relapse.
Reserve surgery for the 'a la carte' approach — posterior release for persistent equinus or tibialis anterior transfer for dynamic supination relapse in older children. And never perform extensive posteromedial release as a primary treatment.
Dobbs and Gurnett (2009) review the etiology and treatment of congenital talipes equinovarus, covering what is known about genetic and environmental causation, the historical arc from forceful manipulation to extensive surgical release, and the evidence supporting the Ponseti method as current gold standard. The review addresses when and how surgery remains appropriate in the modern era.
When you see a newborn with clubfoot, start Ponseti casting within the first weeks of life, anticipate Achilles tenotomy in over 90% of cases, and counsel families that brace compliance for 4 years is the single most important factor in preventing relapse.
Reserve surgery for the 'a la carte' approach — posterior release for persistent equinus or tibialis anterior transfer for dynamic supination relapse in older children. And never perform extensive posteromedial release as a primary treatment.