A Modified Ponseti Method for Skeletally Mature Complex Foot Deformities

Background: Managing skeletally mature complex foot deformities (CFDs) remains challenging, and the effectiveness of the Ponseti method (PM) beyond childhood is not established. This study assesses improvements in foot deformity among adolescent and adult patients with idiopathic and acquired CFD treated with serial casting as a presurgical correction strategy. Methods: A retrospective cohort study encompassing 58 skeletally mature patients (78 feet) with idiopathic or acquired CFD treated with a modified PM between 2020 and 2024 was conducted. Patients were categorized by etiology, and deformity severity in cavus, varus, adductus, and equinus was documented at baseline, after casting, and postoperatively. Analysis of variance and Tukey honestly significant difference test assessed changes over time. Postoperative and casting complications, relapses, and Foot and Ankle Outcome Score (FAOS) were reported at final follow-up. Results: Twenty-eight patients with idiopathic CFD and 30 with acquired CFD were studied. After casting, 95% (55/58) required additional procedures. A plantigrade foot was achieved in 89% (69/78). Seventy-seven percent (60/78) of feet required procedures in addition to Achilles tenotomy. Improvements across all deformity planes were attributable to serial casting ( P < .001), and postoperatively, equinus improved significantly ( P < .04 and P < .01) in both groups. Casting-related injuries needing wound care occurred in 8.9% (7/78). After a median follow-up of 17 months, 13% (10/78) experienced relapse. Postoperative complications included 1 wound dehiscence and 1 case of stiffness. The median FAOS for idiopathic and acquired groups were 87 and 85, respectively. Conclusion: A modification of the PM, using serial leg casting as a preoperative correction strategy for idiopathic and acquired CFD was associated with reduced need for, or reduced complexity of, major reconstructive foot surgery, with high rates of plantigrade feet and low rates of arthrodesis. This approach could redefine treatment paradigms in resource-constrained settings and for multiplanar correction of foot deformity.