Normalization of Forefoot Supination After Tibialis Anterior Tendon Transfer for Dynamic Clubfoot Recurrence.

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Abstract

[Indexed for MEDLINE] 13. J Pediatr Orthop. 2019 Jan;39(1):38-41. doi: 10.1097/BPO.0000000000000953. Management of Clubfoot Relapses With the Ponseti Method: Results of a Survey of the POSNA Members. Hosseinzadeh P(1), Kiebzak GM(2), Dolan L(3), Zionts LE(4), Morcuende J(3). Author information: (1)Miami Orthopedics and Sports Medicine Institute, Baptist Children's Hospital. (2)Pediatric Orthopedic Center, Baptist Children's Hospital, Miami, FL. (3)Department of Orthopedics, University of Iowa, Iowa City, IA. (4)Department of Orthopedics, David Geffen School of Medicine at UCLA, Los Angeles, CA. BACKGROUND: Despite the high rate of initial success using the Ponseti method to manage idiopathic clubfoot deformity, relapse continues to be a problem. We surveyed the Pediatric Orthopedic Society of North America (POSNA) members about their experience with relapsed deformity following the initial correction of clubfeet. METHODS: We created a survey to focus on the management of clubfeet after initial correction of deformity. The survey included questions on postcorrective bracing, clinical findings used to identify relapse, the observed frequency of relapsed deformity, and how relapses are managed. The questionnaire was approved by the POSNA Evidence Based Committee and was sent electronically to all POSNA members. RESULTS: We received responses from 321 members (26%). Of those, 94% were fellowship trained in pediatric orthopaedics. The Ponseti method was used by 98% of respondents. The Mitchell-Ponseti orthosis was most commonly used (51%), followed by the Denis-Browne brace (25%). The duration of bracing used varied among members with 23% recommending only 2 years, 33% recommending 3 years, and 34% recommending 4 years. A tight heel cord was felt to be the first sign of relapse by 59% of respondents, and dynamic supination by 30%. The rate of relapse was observed to be