Results of the Ponseti method in patients with clubfoot associated with arthrogryposis.

Clubfoot associated with arthrogryposis has been traditionally considered very resistant to manipulation and casting, and therefore has required surgical correction. The purpose of this study was to evaluate the results of the Ponseti method of clubfoot casting in this patient population. We reviewed the records of patients with clubfoot associated with arthrogryposis consecutively treated at our respective institutions from January 1992 to December 2004. All patients were treated by serial manipulations and casting following the principles of the Ponseti method. Main outcome measures included initial correction of the deformity, relapses and the need for surgical releases or any other surgeries. Average age at last follow up was 4.6 years. There were 16 patients, all with bilateral deformities (32 clubfeet). there were 11 males and 5 females. Nine patients had both upper and lower extremity involvement. Seven patients had previous treatment elsewhere and one patient had an Achilles tenotomy. Initial correction was obtained in all but 1 patient. Average number of casts required for correction was 7 (range: 5 to 12). Average post-tenotomy dorsiflexion was 5 degrees. One patient required a posterior-medial release (PMR) for insufficient initial correction. Four cases required subsequent surgery for relapses (1 bilateral PMR with a repeat left PMR; 2 posterior releases (PR), 1 PR and anterior tibialis transfer (ATT), and 1 ATT). No talectomies were required. This study demonstrates that the Ponseti method is very effective for the correction of patients with clubfoot associated to arthrogryposis. Although this deformity is more rigid than in idiopathic clubfoot, many cases can be corrected when started in the first few weeks after birth.