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Treatment of Neuromuscular and Syndrome-Associated (Nonidiopathic) Clubfeet Using the Ponseti Method

Janicki, Joseph A. MD*; Narayanan, Unni G. MBBS, MSc, FRCSC; Harvey, Barbara BHScPT; Roy, Anvesh MBBS; Ramseier, Leonhard E. MD; Wright, James G. MD, MPH, FRCSC

Journal of Pediatric Orthopaedics: June 2009 - Volume 29 - Issue 4 - p 393-397
doi: 10.1097/BPO.0b013e3181a6bf77
Neuromuscular: Original Article

Background: Clubfeet are associated with many neuromuscular and congenital conditions. Nonidiopathic clubfeet are typically thought to be resistant to nonoperative management. The Ponseti method has revolutionized the treatment of patients with idiopathic clubfeet. The purpose of this study was to describe the use of the Ponseti method in the treatment of patients whose clubfeet are associated with a neuromuscular diagnosis or a syndrome.

Methods: All patients with clubfeet who were treated at the Hospital for Sick Children, Toronto, from 2001 to 2005 were reviewed. Patients were included only if a neuromuscular condition or a syndrome associated with clubfeet could be identified and if the primary treatment was at our institution. Twenty-three patients with 40 nonidiopathic clubfeet and 171 patients with 249 idiopathic clubfeet have been treated with a minimum follow-up time of 1 year. The outcomes evaluated included the number of casts, the percentage of patients requiring percutaneous Achilles tendon lengthening (tenotomy of the Achilles tendon [TAT]), rate of recurrences, rate of failures, and the need for additional secondary procedures.

Results: The mean age at presentation for nonidiopathic clubfeet was 11 weeks. The mean follow-up time was 33 months, and the mean number of casts was 6.4; a percutaneous TAT was necessary in 27 (68%) of 40 feet. Failure of the Ponseti casting occurred in 4 (10%) of the 40 feet. Recurrence requiring additional treatment occurred in 16 (44%) of 36 feet. Additional procedures included second percutaneous TAT, limited posterior/plantar release, or complete posteromedial release totaling 11 (28%) of 40. When compared with idiopathic clubfeet, nonidiopathic clubfeet required more casts and had a higher rate of failures, recurrences, and additional procedures than idiopathic clubfeet.

Conclusions: Although not as successful as for idiopathic clubfeet, when the Ponseti technique is applied to nonidiopathic clubfeet, correction can be achieved and maintained in most patients.

Level of Evidence: Prognostic level 2.

From the *Children's Memorial Hospital, Chicago, IL; †Hospital for Sick Children, Toronto, Ontario, Canada; and ‡University Children's Hospital Zurich, Zurich, Switzerland.

The study was conducted at the Division of Pediatric Orthopaedics, Hospital for Sick Children, University of Toronto, Toronto, Ontario Canada.

None of the authors or their divisions received anything of value for this study.

Reprints: Joseph A. Janicki, MD, Orthopaedic Surgery, Children's Memorial Hospital, Northwestern University, 2300 Children's Plaza, Box 69, Chicago, IL 60614-3394. E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.