This Level V current concepts review by Eidelman, Kotlarsky, and Herzenberg organizes surgical management of relapsed, residual, and neglected clubfoot into an age-based treatment algorithm. It catalogues soft-tissue and bony adjunctive procedures available beyond standard Ponseti casting, and introduces the 'Ponse-Taylor method' of hexapod-assisted correction for rigid feet.
A Ponseti-treated child presenting with recurrent equinus and supination is a common clinic scenario, and the management decision turns entirely on age and brace compliance.
Under 2.5 years: recast with Ponseti technique and aggressively reinforce FAB — surgery is not yet indicated. Ages 2.5–8: if the foot is passively correctable, proceed to TATT ± TAL; if stiff, cast first until passively correctable, then transfer. Adolescents with rigid multiplanar deformity: osteotomy with hexapod correction is preferred over repeat soft-tissue release, which yields scarring and permanent stiffness without meaningful correction.
This paper also establishes a critical surgical sequence rule: posterior capsulotomy and TATT cannot be combined in one sitting because their postoperative immobilization requirements conflict. 3 weeks for capsulotomy versus 6 weeks for tendon transfer.
For any relapsed foot, the Meary angle on stress lateral radiograph distinguishes forefoot equinus (cavus, treated with plantar fasciotomy) from hindfoot equinus (treated with TAL). Getting this distinction right prevents operating on the wrong level.
This Level V current concepts review by Eidelman, Kotlarsky, and Herzenberg organizes surgical management of relapsed, residual, and neglected clubfoot into an age-based treatment algorithm. It catalogues soft-tissue and bony adjunctive procedures available beyond standard Ponseti casting, and introduces the 'Ponse-Taylor method' of hexapod-assisted correction for rigid feet.
A Ponseti-treated child presenting with recurrent equinus and supination is a common clinic scenario, and the management decision turns entirely on age and brace compliance.
Under 2.5 years: recast with Ponseti technique and aggressively reinforce FAB — surgery is not yet indicated. Ages 2.5–8: if the foot is passively correctable, proceed to TATT ± TAL; if stiff, cast first until passively correctable, then transfer. Adolescents with rigid multiplanar deformity: osteotomy with hexapod correction is preferred over repeat soft-tissue release, which yields scarring and permanent stiffness without meaningful correction.
This paper also establishes a critical surgical sequence rule: posterior capsulotomy and TATT cannot be combined in one sitting because their postoperative immobilization requirements conflict. 3 weeks for capsulotomy versus 6 weeks for tendon transfer.
For any relapsed foot, the Meary angle on stress lateral radiograph distinguishes forefoot equinus (cavus, treated with plantar fasciotomy) from hindfoot equinus (treated with TAL). Getting this distinction right prevents operating on the wrong level.