Non-idiopathic Clubfeet: A Current Concepts Review

The primary goal in managing non-idiopathic clubfeet is to attain a painless and plantigrade foot with as least number of procedures as possible. Preferably, it should be achieved before the walking age to prevent the adaptive changes in the bone. Serial casting by the Ponseti technique is gaining favor for primary management of these feet with encouraging initial correction results. However, recurrence of variable degree is expected. Certain modifications to the treatment are advisable in view of the non-pliability of these feet and high recurrence rates. Manipulation and plastering techniques similar to atypical feet maneuvers need to be practiced very often. Some rigid cases also need an early Achilles tenotomy or limited posterior soft tissue release (STR). The final goal is achieving brace-able plantigrade feet, but in view of the rigidity, an endpoint of abduction correction to 30-40 with 5-10 of dorsiflexion is acceptable. Ankle foot orthosis (AFO) in cases with concurrent hip and knee contractures is preferred over standard foot abduction braces (FAB). Recent literature showed that the number of non-idiopathic clubfeet undergoing extensive STR or radical bony procedures has drastically reduced over the years. The jury is still out about consensus on the ideal protocol.