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Congenital idiopathic atypical clubfoot: reordering the steps of modified Ponseti method with minor modification of the technique

Background The Ponseti method has shown remarkable success in treating congenital idiopathic clubfoot. However, some feet with complex or atypical presentation do not respond to the standard protocol of manipulation and casting. Patients and methods A total of 26 consecutive infants (39 feet) with idiopathic atypical clubfeet, diagnosed according to the clinical criteria proposed by Ponseti, were assessed. The average age at presentation was 13 weeks (range, 2–39). The classic Ponseti technique with reordering of the steps and some modifications was used. Results The mean follow-up was for 33 months (range, 20–60). The results of the treatment were evaluated using the Pirani and Dimeglio scoring systems. The mean precorrection Dimeglio score was 17.3 (range, 15–20), and the mean postcorrection Dimeglio score was 3.34 (range, 3–5). This difference was statistically significant (P<0.001). A mean of six casts (range, 5–8) were required for full correction. Three (11.5%) patients had a relapse after initial successful treatment and required a second series of manipulation, casting, and redo-Achilles tenotomy. At the latest review, all affected feet were painless, with a mean ankle dorsiflexion of 15° (range, 10–20°). Conclusion Reordering the steps of modified Ponseti method for complex clubfeet with some modifications can be successfully used for treatment of infants with atypically presented clubfoot.