Treatment of neglected and relapsed clubfoot deformities

What is it about?

Clubfoot deformities, both the idiopathic and the teratologic types, have a high tendency to relapse. This is irrespective of the initial treatment type (casting versus surgery). This article reviews the literature on various methods of treatment for these relapses.

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Why is it important?

Tibialis anterior tendon transfers help rebalance relapsed clubfeet but only feet that are passively correctable.
Extensive soft tissue releases for clubfoot relapse have a high rate of recurrence; the results are better in older children than in younger ones.
The Evans and Lichtblau procedures lead to subtalar stiffness and gradual deterioration of results over time.
Osteotomies across the cuneiform-cuboid axis only correct forefoot deformities and do not address hindfoot varus.
Neglected and severe relapsed clubfeet can be corrected gradually with external fixators.  Correcting with osteotomies and external fixators has a high rate of recurrence.  Using external fixators for gradual correction after soft tissue releases does not provide consistent results.  Soft tissue distraction with an external fixator allows for clubfoot correction with decreased risks of neurovascular injury and a lower rate of recurrence.
The Ponseti method of serial casting is a valid treatment option for nearly all neglected and relapsed clubfeet, except for those with bony synostoses or arthrodeses.

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