Retrospective multicenter case series from five Ponseti-method institutions identifying and defining a distinct subset of idiopathic clubfeet — 'complex' clubfeet — that fail standard manipulation protocols, and describing the clinical criteria and modified casting technique required to correct them without extensive surgery.
When you see a clubfoot with a transverse plantar crease, deep heel crease, and short hyperextended first toe, recognize it as the complex variant before you start casting — applying standard forefoot abduction to these feet drives the plantar-flexed metatarsals into grotesque deformity, while the modified simultaneous dorsiflexion technique corrects virtually all cases without surgery.
Retrospective multicenter case series from five Ponseti-method institutions identifying and defining a distinct subset of idiopathic clubfeet — 'complex' clubfeet — that fail standard manipulation protocols, and describing the clinical criteria and modified casting technique required to correct them without extensive surgery.
When you see a clubfoot with a transverse plantar crease, deep heel crease, and short hyperextended first toe, recognize it as the complex variant before you start casting — applying standard forefoot abduction to these feet drives the plantar-flexed metatarsals into grotesque deformity, while the modified simultaneous dorsiflexion technique corrects virtually all cases without surgery.