Ponseti Clubfoot Clinic

Managing Relapse

Most common cause is non-compliance with bracing protocol

Recast as soon as relapse is identified to achieve 30 DF and 60 ER then continue bracing

Equinus relapse

1. serial cast to get the foot DF > 15 degrees
2. if this fails, repeat tenotomy < 2yo then 3 - 4 weeks in post-op cast
3. open achilles lengthening for older children (rarely required)

Varus relapse

the ankle starts to roll out and your child will be walking on the outside of their affected foot/feet

• more common than equinus
• cast then continue bracing

Dynamic Supination

This is common and in 50% of cases that have fully flexible feet (i.e. no structural deformity) your childs foot while walking will still pull in and turn up (i.e. dynamic supination) due to muscle imbalance around the ankle.

Your surgeon can improve this imbalance by doing a tibialis anterior tendon transfer, which can be performed between 2 - 4 yrs of age.