Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 16, 2016; 4(10): 318-322
Published online Oct 16, 2016. doi: 10.12998/wjcc.v4.i10.318
Factors associated with recurrence of clubfoot treated by the Ponseti method
Mohammad Reza Azarpira, Mohammad Jafar Emami, Amir Reza Vosoughi, Keivan Rahbari
Mohammad Reza Azarpira, Mohammad Jafar Emami, Amir Reza Vosoughi, Keivan Rahbari, Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz 71948-15644, Iran
Author contributions: Azarpira MR, Emami MJ designed, guided the research and interpreted the data; Vosoughi AR, Rahbari K collected data and contributed to the analysis; all authors participated in drafting the article and they critically reviewed the manuscript and approved the final manuscript as submitted.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Shiraz University of Medical Sciences and Institutional Review Board of Bone and Joint Diseases Research Center, Shiraz Iran.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used clinical data obtained from their files after follow-up visits of the patients who had been agreed to treatment previously by written consent.
Conflict-of-interest statement: We have no financial relationships to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Amir Reza Vosoughi, MD, Assistant Professor of Orthopedic Surgery, Foot and Ankle Surgeon, Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz 71948-15644, Iran.
Telephone: +98-713-6234504 Fax: +98-713-6246093
Received: March 12, 2016
Peer-review started: March 14, 2016
First decision: May 19, 2016
Revised: June 26, 2016
Accepted: August 6, 2016
Article in press: August 8, 2016
Published online: October 16, 2016

To assess several associated factors on the recurrence of clubfoot after successful correction by the Ponseti method.


A total of 115 children with 196 clubfeet deformities, treated by the Ponseti method, were evaluated. Demographic data, family history of clubfoot in first-degree relatives, maternal educational level and brace compliance were enquired. Based on their medical files, the characteristics of the patients at the time of presentation such as age, possible associated neuromuscular disease or especial syndrome, severity of the deformity according to the Dimeglio grade and Pirani score, residual deformity after previous Ponseti method and number of casts needed for the correction were recorded.


There were 83 boys (72.2%) and 32 girls (27.8%) with a male to female ratio of 2.6. The mean age at the initiation of treatment was 5.4 d (range: 1 to 60 d). The average number of casts applied to achieve complete correction of all clubfoot deformities was 4.2. Follow-up range was 11 to 60 mo. In total, 39 feet had recurrence with a minimum Dimeglio grade of 1 or Pirani score of 0.5 at the follow-up visit. More recurrence was observed in non-idiopathic clubfoot deformities (P = 0.001), non-compliance to wear braces (P < 0.001), low educational level of mother (P = 0.033), increased number of casts (P < 0.001), and more follow-up periods (P < 0.001). No increase in the possibility of recurrence was observed when the previous unsuccessful casting was further treated using the Ponseti method (P = 0.091). Also, no significant correlation was found for variables of age (P = 0.763), Dimeglio grade (P = 0.875), and Pirani score (P = 0.624) obtaining at the beginning of the serial casting.


Using the Ponseti method, non-idiopathic clubfoot, non-compliance to wear braces, low educational level of mother, increased number of casts and more follow-up periods had more association to possible increase in recurrence rate after correction of clubfoot deformity.

Keywords: Clubfoot, Recurrence, Cast, Talipes equinovarus, Ponseti

Core tip: This is a retrospective study to determine factors responsible for the unsuccessful treatment of clubfoot using the Ponseti method. Recurrence of each or all major components of clubfoot deformity was seen in 39 feet among 196 feet during follow-up range of 11 to 60 mo. Recurrence was higher in patients with non-idiopathic clubfoot, non-compliance to wear braces, low maternal educational level, increased number of casts needed to correct the deformity and more follow-up periods.