Evaluation of the functional outcome measures of recurrent clubfeet after posteromedial or posterior release treated using the Ponseti method: a preliminary study

The Ponsetimethod has been popularized for treating recurrent idiopathic clubfoot and, more recently, recurrent clubfoot following posteromedial (PMR) or posterior (PR) release. A retrospective study was performed to determine the functional outcome in Ponseti treatment of recurrent idiopathic clubfoot after PMR or PR. The study also aimed to determine whether clinical scoring systems (Pirani and Dimeglio scores) could be predictive for the initial numbers of casts, Achilles tenotomy, ankle dorsiflexion after initial treatment, relapse, and functional outcomes following the Ponseti method of treatment. This was a retrospective study of 17 consecutive patients (27 feet) treated with the Ponseti method for recurrent clubfoot after PMR or PR. Clinical charts were reviewed for sex, laterality, age at initial visit to our institution, age at the first surgery, initial number of casts, undergoing a percutaneous Achilles tenotomy (PAT) or not, clinical presentation, Pirani and Dimeglio scores, range of motion of ankle dorsiflexion after initial treatment, the International Clubfoot Study Group (ICFSG) rating system, and recurrences following the Ponseti method of treatment. We conducted descriptive statistical analyses between patients who rated as excellent, or good and fair in the ICFSG rating system following the Ponseti method of treatment. Outcome and demographic data were analyzed using an independent student’s t-test for means and Fisher exact test for proportional data. Dimeglio and Pirani scores were not helpful in predicting whether or not a PAT was performed (p > 0.01), ankle dorsiflexion after initial treatment (p > 0.01), and relapse after initial treatment (p > 0.01). There was no statistical correlation between functional outcomes and the number of serial casts (p > 0.01), undergoing a PAT or not, (p > 0.01), ankle dorsiflexion (p > 0.01), and relapse (p > 0.01) after initial treatment. We found a statistical relationship between the initial clinical severity and the number of casts required for clubfoot correction (p = 0.005), and a significant statistical correlation between the initial scores of Pirani (p = 0.001) and Dimeglio (p < 0.001) with the final scores of the ICFSG rating system. Ponseti treatment for recurrent idiopathic clubfoot following PMR or PR achieved a satisfactory functional outcome in most patients. The Dimeglio and Pirani scoring systems provided a prognostic value for the initial number of casts and functional outcomes for clubfeet recurring after PMR or PR treated by the Ponseti method. The better functional outcomes were attributed to less initial severity of the previously operated clubfeet. Level IV, therapeutic study.