Is there a Role of Posterior Medial Soft-tissue Release in the Era of Ponseti Treatment for Club Foot?

Abstract Background: With the advent of Ponseti serial casting, the club foot management has swung in favor of conservative treatment, limiting the indications of extensile soft-tissue release surgeries to very few, which are undefined. This study was done to delineate the indications in which posterior medial soft-tissue release (PMSTR) can be done successfully. Materials and Methods: We performed PMSTR in 22 feet with neglected, relapse or resistant congenital talipes equinovarus presenting between age 1 and 2 years and evaluated the outcome by Pirani score and Ferreira score. Results: Ten cases had unilateral involvement and 6 had bilateral involvement. The mean age at the time of the surgery was 13.3 months (range 12–21 month). Fourteen cases (6 unilateral and 4 bilateral) were neglected, whereas 7 case (3 unilateral and two bilateral) were case of relapse. The mean follow-up of the children was 28.6 months (range: 24–38 months). The mean number of visit postsurgery including the final visit at 2 years were 3.2 (range 3–5). The mean pretreatment Pirani score was 5.6 (range 4–6) which improved to mean Pirani score after surgery of 0.8 (range: 0–2.5). As per Ferreira score, good results were obtained in 20 (90.9%) feet, fair results in 1 (4.5%) feet, and poor results in 1 (4.5%) feet. Conclusion: PMSTR is one-stage poster-medial soft-tissue release performed around the age of 1 year is important tools in the armamentarium for specific cases of relapse, resistant, and residual cases of clubfoot with excellent outcome and which gives a normally looking and functionally acceptable pain free foot, without multiple visits to the center.