Consecutive case series of 157 patients (256 feet) treated with the Ponseti method at the University of Iowa from 1991–2001. The study asks: how often does serial manipulation-and-casting achieve durable clubfoot correction without extensive surgery, and what drives relapse when it occurs?
Before Ponseti's technique was widely adopted, extensive posteromedial release surgery was standard for clubfoot — performed in 50–90% of cases and complicated by stiffness, pain, and revision rates up to 47%.
When you see a newborn with congenital idiopathic clubfoot, start Ponseti casting regardless of deformity severity or prior failed casting elsewhere. Surgery is the last resort, not the default. This paper is why that practice changed.
When correction is achieved, treat brace compliance as the single modifiable risk factor for relapse and counsel families at every visit. The brace must be worn full-time for 2–3 months, then nightly until age 3–4 years.
If a patient relapses and the anterior tibial muscle is supinating the foot during gait, anterior tibial tendon transfer to the third cuneiform is the procedure of choice to prevent further recurrence.
Consecutive case series of 157 patients (256 feet) treated with the Ponseti method at the University of Iowa from 1991–2001. The study asks: how often does serial manipulation-and-casting achieve durable clubfoot correction without extensive surgery, and what drives relapse when it occurs?
Before Ponseti's technique was widely adopted, extensive posteromedial release surgery was standard for clubfoot — performed in 50–90% of cases and complicated by stiffness, pain, and revision rates up to 47%.
When you see a newborn with congenital idiopathic clubfoot, start Ponseti casting regardless of deformity severity or prior failed casting elsewhere. Surgery is the last resort, not the default. This paper is why that practice changed.
When correction is achieved, treat brace compliance as the single modifiable risk factor for relapse and counsel families at every visit. The brace must be worn full-time for 2–3 months, then nightly until age 3–4 years.
If a patient relapses and the anterior tibial muscle is supinating the foot during gait, anterior tibial tendon transfer to the third cuneiform is the procedure of choice to prevent further recurrence.