Vol. 11, Issue 4 (2025)

Background and Objectives: Clubfoot is one of the most common foot deformity found in newborns. While the Ponseti method is highly effective for typical idiopathic cases, a subset of patients presents with atypical or complex clubfoot, characterized by resistance to correction and a higher incidence of relapse. Literature is sparse on its etiology, and its unique phenotypic features often complicate management. To address these challenges, a modified Ponseti method has been developed.

Materials and Methods: This study included 45 atypical clubfeet from 30 patients under 1 year of age, treated between April 2023 and November 2024 using the modified Ponseti method. Relevant perinatal and postnatal histories were recorded. Pirani scores were assessed weekly. Treatment involved serial manipulation and casting according to the modified Ponseti method, followed by percutaneous tendoachilles tenotomy. A post-tenotomy cast was applied in 10° dorsiflexion and 110° knee flexion for three weeks. After cast removal, a foot abduction brace was applied. Follow-up visits assessed on brace compliance and relapse.

Results: The average age at presentation was 3.5 months (56.7%), with a male-to-female ratio of 3:1. Bilateral involvement was seen in 50%, and 10% had a positive family history. The mean number of casts required before tenotomy was 7.16 per foot. Mean Pirani score improved from 5.8 ±0.3 at presentation to 1.1 ±0.4 post tenotomy (p< 0.001). Cast slippage occurred in 23.3%, relapse in 10%, and minor skin complications were noted in 10 children. Following tenotomy, 86.7% of cases achieved functional dorsiflexion of >10°. Follow-up continued for up to 18 months.

Conclusion: The modified Ponseti method is an effective first-line treatment for atypical clubfoot, achieving functional correction with minimal complications. It significantly reduces the need for complex bony surgeries and extensive soft tissue release procedures.