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Comparison of the short-term and long-term results of the Ponseti method in the treatment of idiopathic pes equinovarus



Congenital club foot is one of the most common birth defects involving the musculoskeletal system. At present two methods are used for the treatment of this deformity: French and Ponseti method. The purpose of this study was to compare the short-term (up to three years) and long-term (three to seven years) results of treatment with the Ponseti method.


A total of 195 consecutive infants (143 boys and 52 girls) with idiopathic club foot treated with the Ponseti method in the period of 2005–2012 were included in this study; the total number of feet was 303. The severity of the foot deformity was classified according to Diméglio. When relapse occurred up until three years of age, we started with the casting again. If conservative treatment was unsuccessful we proceeded to surgical treatment.


Primary correction was attained in all cases. Surgical correction of relapses was performed in 30 % of patients according to the Ponseti method (re-tenotomy of the Achilles tendon and transposition of the tibialis anterior) and in 70 % by alternative techniques. The number of relapses indicated for surgery increased with increasing period of follow-up: whereas in patients where the treatment started already in 2005 relapses occurred in 72 %, in patients included in 2011 the number of recurrences only reached 3 %.


It follows from our results that it is impossible to cure all club feet with casting, tenotomy of the Achilles tendon and transposition of the tibialis anterior only.

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  1. Wynne-Davies R (1965) Family studies and aetiology of club foot. J Med Genet 2(4):227–232

    Article  PubMed  CAS  Google Scholar 

  2. Ponseti IV (1992) Treatment of congenital club foot. J Bone Joint Surg Am 74:448–454

    PubMed  CAS  Google Scholar 

  3. Dobbs MB, Rudzki JR, Purcell DB, Walton T, Porter KR, Gurnett CA (2004) Factors predictive of outcome after use of the Ponseti method for the treatment of idiopathic clubfeet. J Bone Joint Surg Am 86:22–27

    PubMed  Google Scholar 

  4. Kite JH (1972) Nonoperative treatment of congenital clubfoot. Clin Orthop Relat Res 84:29–38

    Article  PubMed  CAS  Google Scholar 

  5. Yamamoto H, Muneta T, Morita S (1998) Nonsurgical treatment of congenital clubfoot with manipulation, cast, and modified Denis Browne splint. J Pediatr Orthop 18:538–542

    PubMed  CAS  Google Scholar 

  6. Diméglio A, Bensahel H, Souchet P, Mazeau P, Bonnet F (1995) Classification of clubfoot. J Pediatr Orthop B 4:129–136

    Article  PubMed  Google Scholar 

  7. Ponseti IV, Smoley EN (1963) Congenital club foot: the results of treatment. J Bone Joint Surg Am 45:261–344

    Google Scholar 

  8. Ponseti IV, Zhivkov M, Davis N, Sinclair M, Dobbs MB, Morcuende JA (2006) Treatment of the complex idiopathic clubfoot. Clin Orthop Relat Res 451:171–176

    Article  PubMed  Google Scholar 

  9. Ponseti IV (1996) Congenital clubfoot: fundamentals of treatment, 1st edn. Oxford University Press, Oxford, p 140

    Google Scholar 

  10. Ponseti IV (2000) Clubfoot management. J Pediatr Orthop 20:699–700

    Article  PubMed  CAS  Google Scholar 

  11. Herzenberg JE, Radler C, Bor N (2002) Ponseti versus traditional methods of casting for idiopathic clubfoot. J Pediatr Orthop 22(4):517–521

    PubMed  Google Scholar 

  12. Dogan A, Kalender AM, Seramet E, Uslu M, Sebik A (2008) Mini-open technique for the achilles tenotomy in correction of idiopathic clubfoot: a report of 25 cases. J Am Podiatr Med Assoc 98(5):414–417

    PubMed  Google Scholar 

  13. Iltar S, Uysal M, Alemdaroğlu KB, Aydoğan NH, Kara T, Atlihan D (2010) Treatment of clubfoot with the Ponseti method: should we begin casting in the newborn period or later? J Foot Ankle Surg 49:426–431

    Article  PubMed  Google Scholar 

  14. Idelberger K (1939) Die Ergebnisse der Zwillingsforschung beim angeborenen Klumpfuss. Verh Dtsch Orthop Ges 33:272–276

    Google Scholar 

  15. Lochmiller C, Johnston D, Scott A, Risman M, Hecht JT (1998) Genetic epidemiology study of idiopathic talipes equinovarus. Am J Med Genet 79(2):90–96

    Article  PubMed  CAS  Google Scholar 

  16. Sano H, Uhthoff HK, Jarvis JG, Mansingh A, Wenckebach GF (1998) Pathogenesis of soft-tissue contracture in club foot. J Bone Joint Surg Br 80:641–644

    Article  PubMed  CAS  Google Scholar 

  17. Morcuende JA, Dolan LA, Dietz FR, Ponseti IV (2004) Radical reduction in the rate of extensive corrective surgery for clubfoot using the Ponseti method. Pediatrics 113:376–380

    Article  PubMed  Google Scholar 

  18. Radler C, Manner HM, Suda R, Burghardt R, Herzenberg JE, Ganger R, Grill F (2007) Radiographic evaluation of idiopathic clubfeet undergoing Ponseti treatment. J Bone Joint Surg Am 89:1177–1183

    Article  PubMed  Google Scholar 

  19. Abdelgawad AA, Lehman WB, van Bosse HJ, Scher DM, Sala DA (2007) Treatment of idiopathic clubfoot using the Ponseti method: minimum 2-year follow-up. J Pediatr Orthop B 16(2):98–105

    Article  PubMed  Google Scholar 

  20. Yagmurlu MF, Ermis MN, Akdeniz HE, Kesin E, Karakas ES (2011) Ponseti management of clubfoot after walking age. Pediatr Int 53:85–89

    Article  PubMed  Google Scholar 

  21. Gibbons PJ, Gray K (2013) Update on clubfoot. J Paediatr Child Health. doi:10.1111/jpc.12167

    Google Scholar 

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The authors declare that they have no conflict of interest.

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Correspondence to Martin Ošťádal.

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Ošťádal, M., Chomiak, J., Dungl, P. et al. Comparison of the short-term and long-term results of the Ponseti method in the treatment of idiopathic pes equinovarus. International Orthopaedics (SICOT) 37, 1821–1825 (2013).

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