Prospective Analysis of Relapse Patterns in Clubfoot Treated with the Ponseti Technique in Peshawar, Pakistan

BACKGROUND: Clubfoot relapse is a common occurrence following the Ponseti technique, potentially progressing from flexible to rigid deformity if untreated. OBJECTIVE: This study aimed to analyze the patterns of relapse observed in clubfeet treated with the Ponseti method. METHODOLOGY: A prospective study involving 250 patients were conducted at the clubfoot department in Peshawar. Patient data, including age, initial Pirani score, number of casts required, gender, and affected foot, were taken from hospital records. Statistical analysis was performed using SPSS version 22, with significance set at a p-value of less than 0.05. RESULTS: The study involved 151 cases of bilateral relapse clubfoot and 99 cases of unilateral relapse clubfoot. Patients with bilateral relapse clubfoot had a mean age of 11.20 days, whereas those with unilateral relapse clubfoot had a mean age of 9.60 days. The mean Pirani score for bilateral relapse clubfoot was 5.67, slightly higher than the score of 5.5 for unilateral cases. On average, patients with bilateral relapse clubfoot required 6.4 casts, while those with unilateral relapse clubfoot needed slightly fewer casts, with a mean of 6.3. Analysis of relapse patterns revealed similar trends in both groups, with decreased ankle dorsiflexion (DF) up to neutral, dynamic forefoot adduction/supination, and rigid equinus being the most common patterns observed. CONCLUSION: This study identified five distinct subsets for classifying relapsed clubfoot deformities such as decreased ankle dorsi-flexion (DF) (28.1%), Rigid Equinus (16.8%), Dynamic forefoot supination/adduction (34.4%), fixed adduction of midfoot and forefoot (9.98%), and complete relapse pattern (10.9%). Early identification and intervention of relapses are crucial to mitigate the need for major soft tissue surgeries. KEYWORDS: Clubfoot, Ponseti Method, Relapse Pattern