Predictors of Clubfoot Recurrence over the Age of 2 Years

Amit Davidson Tamar M Berenstein-Weyel Michael Karasik Ehud Lebel
Orthopaedic Suregery, Shaare-Zedek Medical Center, affiliated with the Hebrew University School of Medicine, Jerusalem, Israel

Background: Serial manipulation and application of a cast is the mainstay of modern clubfoot correction (Ponseti method). As correction is achieved, a foot-abduction-brace (FAB) is used to prevent regression. After completion of this first stage of management, follow-up is crucial for detection of regression. Recurrence or residual deformity mandates repeated treatment including surgery. This study evaluates the rate of recurrent deformity and patient characteristics that may lead to recurrence.

Methods: Data were retrospectively collected of all babies born with clubfoot between 2011 and 2014 in a single hospital and had an un-interrupted follow-up beyond the age of 2 years.

Results: 82 babies were born with clubfoot during this period. Only 42 (51%) had >2 years continuous follow-up. Evaluation of background revealed 37/42 (88%) babies with simple clubfoot and 5 (12%) with syndromic background or atypical features. Further treatment was indicated in 18 (43%) children; 4 (22%) were atypical/syndromic and 5 (28%) abandoned FAB earlier than recommended. Weak evertors activity was diagnosed in 11/14 (73%) of remaining uncorrected simple-clubfoot.

Discussion-conclusions: The definition of recurrence in clubfoot is based on the treating surgeon’s experience and attitude rather than acknowledged clinical features. This study demonstrates that other than complex-clubfoot (syndromatic or atypical), weak evertor muscle activity is a substantial predictor of unsatisfactory or recurrent clubfoot deformity beyond the age of 2 years. Low compliance with FAB is noteworthy in this patient population.