Current Concepts in the Etiology, Diagnosis, and Management of Relapsed Clubfoot

Relapse is a recurrence of deformities in a previously corrected clubfoot. The incidence of relapse after the Ponseti method is reported between 26% and 48%. The etiology of relapse can be variable. Some of the predisposing factors that are predictive of relapse are drop toe signs, a lower ratio of correction improvement, and muscle imbalance. Relapse can be broadly categorized into decreased dorsiflexion, cavus, equines, adduction, heel varus, and dynamic supination deformity. The principles to be followed in the treatment of relapsed clubfoot are-restarting foot abduction brace protocol, extended Ponseti method and/or soft tissue surgery, bony procedures, and external fixation devices. The Ponseti method can be used even in older children with relapse or after soft tissue surgery. Split tibialis anterior transfer may be required in a child with dynamic supination deformity. It should be performed in children above 3 years. Many children may require >2 procedures. Soft tissue surgery carries the risk of over-and under-correction. The external fixator can be used in children with scarring due to multiple surgeries and severe rigid deformities. Salvage procedures may be required in older children or syndromic clubfeet.