• Oliver Loose, Fernandez FernandezFranciscoFOrthopaedic Department, Klinikum Stuttgart Olgahospital, Kriegsbergstrasse 62, 70174, Stuttgart, Germany., Micha Langendoerfer, Thomas Wirth, and Oliver Eberhardt.
• Orthopaedic Department, Klinikum Stuttgart Olgahospital, Kriegsbergstrasse 62, 70174, Stuttgart, Germany.
• Arch Orthop Trauma Surg. 2023 Oct 1; 143 (10): 609761046097-6104.

IntroductionThe treatment of complex atypical clubfoot poses many challenges. In this paper, we report on the course of complex clubfoot, primary correction using the modified Ponseti method and midterm outcomes. Special consideration is given to clinical and radiological changes in cases of relapse.Materials And MethodsTwenty-seven cases of complex, atypical, non-syndromic clubfoot were treated in 16 children between 2004 and 2012. Patient data, treatment data, functional outcomes and, in the relapse cohort, radiological findings were documented during the course of treatment. The radiological findings were correlated with the functional outcomes.ResultsAll atypical complex clubfeet could be corrected using a modified form of the Ponseti method. Over an average study period of 11.6 years, 66.6% (n = 18) of clubfeet relapsed. Correction after relapse showed an average dorsiflexion of 11.3° during a 5-years' follow-up period. Radiological results showed residual clubfoot pathologies such as a medialized navicular bone in four clubfeet. There were no instances of subluxation or dislocation of the talonavicular joint. Extensive release surgery was not necessary. Nevertheless, after 2.5 preoperative casts (1-5 casts), bone correction was performed in n = 3 feet in addition to Achilles tendon lengthening and tibialis anterior tendon transfer.ConclusionGood primary correction of complex clubfoot using the modified Ponseti technique results in a high recurrence rate in the medium term. Relapse treatment without peritalar arthrolysis procedures produces good functional results even though minor residual radiological pathologies did persist in a minor number of cases.© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

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