Treatment of adult neglected clubfoot with Ponseti method: Consecutive case series of thirty-three feet.

Abstract

There are no prior case series of untreated adults with neglected clubfoot treated with the Ponseti method, and the oldest previously reported case was 30 years old. The objective of this study was to analyze the outcomes of Ponseti treatment in adults with neglected clubfoot. Thirty patients were initially treated using the Ponseti method. Twenty-one patients (33 feet; mean age, 34 years; range, 21-53 years) had at least 12 months of follow-up and were included in the final analysis. Additional bone surgery was performed only in feet that were not fully corrected after serial cast changes and Achilles tenotomy. Statistical analysis was used to correlate the following: number of casts; pre-treatment flexibility and foot rotation; age; additional bone surgery beyond tenotomy; sex; residual deformity; forefoot abduction before tenotomy; and results according to AOFAS score. A total of 85% had rigid or mildly flexible feet. A mean of 11.6 casts (3-25) were performed before the Achilles tenotomy. A total of 33% had additional bone surgery after the Ponseti method (casts and Achilles tenotomy). There was a significant improvement in the AOFAS score (32-79) in a mean follow-up of 32 months. More flexible feet required fewer cast changes and showed better outcomes (p < 0.05). Older age and lower forefoot abduction values after the cast period were positively correlated with the need for additional bone surgery (p < 0.05). The percentage of residual deformity was significantly higher in males (p = 0.03). The method applied proved to be a viable and effective alternative for the treatment of neglected clubfoot in adults.