Rate and predictors of relapse and surgery in idiopathic clubfeet after successful Ponseti treatment in infancy

Listen to Simon and Amy discuss the paper 'Rate and predictors of relapse and surgery in idiopathic clubfeet after successful Ponseti treatment in infancy' published in the October 2025 issue of Bone & Joint Open.

Click here to read the paper.

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Transcript

[00:00:00] Welcome back to another episode of AI Talks with Bone & Joint from the publishers of Bone & Joint Open. Today we're discussing the paper 'Rate and predictors of relapse and surgery in idiopathic clubfeet after successful Ponseti treatment in infancy', published in October 2025 by authors R Gremminger, C Cristofaro, M Sadat, and M Bouchard.

Hello everyone. I'm Lisa, and joining me is my co-host Brian. We have a fascinating study to talk about today, don't we? Indeed.

This study offers some valuable insights into the relapse rates and predictors of surgery and idiopathic club feet after using the Ponseti method. Idiopathic clubfoot is a congenital deformity where the foot appears turned inward and downward.

The Ponseti method, now the gold standard involves a series of gentle manipulations and casts, followed by a minor procedure called a percutaneous Achilles tenotomy and foot abduction bracing to correct the [00:01:00] deformity. It represents a significant shift from more invasive surgical treatments. However, the study highlights that even with this effective method, relapse can still occur.

Precisely. The study aimed to assess the relapse rates and identify risk factors that might necessitate further intervention. They conducted a retrospective review at The Hospital for Sick Children in Toronto, examining patients treated between February 2005 and December 2015.

The cohort included 268 children with 397 idiopathic clubfeet. Interestingly, 63.5% of the children had successful initial treatment without a relapse, but about 36.2% did experience a relapse requiring further interventions. One key finding was that children who relapse presented at a median age of 25.1 days. Which is significantly younger than the 33.7 days for those who did not relapse.

[00:02:00] Also, the number of casts needed for initial correction was higher in the relapse group. Patients who never relapsed required on average 4.3 casts compared to 5.2 casts for those who did relapse and adherence to bracing played a crucial role in outcomes. Good adherence was significantly higher in the no-relapse group at 94.9%, compared to just 62.3% in the relapse group.

Another interesting aspect is the complexity of the clubfoot. A greater proportion of patients with complex-type clubfoot experienced a relapse. It was 18.6% in the relapse group compared to just 4.7% in the no-relapse group.

When it came to surgical intervention, only 23 patients or 5.8% of the total cohort underwent surgery. The most common procedures were tibialis anterior tendon transfer and open tendoachilles lengthening. However, more invasive joint surgeries were [00:03:00] rare.

The findings highlight that while the Ponseti method is highly effective, certain factors such as younger age at presentation, the complexity of the deformity, and poor brace adherence, increase the risk of relapse. The need for surgery is relatively rare thanks to the effectiveness of the Ponseti method.

To sum up most children fare well with Ponseti treatment, but some factors can predict a higher risk of relapse. Ensuring adherence to the bracing protocol is crucial, and although surgery is seldom needed, when it is, the procedures are typically less invasive.

That's correct. It's important for practitioners to monitor high-risk patients closely and ensure follow through with bracing to minimize the chances of relapse. Well, that wraps up today's episode of AI Talks With Bone & Joint. Thank you for tuning in. Be sure to check out the full study in Bone & Joint Open.

Until next time, this is Lisa and Brian signing off.