Calf circumference discrepancies in patients with unilateral clubfoot: Ponseti versus surgical release

J Pediatr Orthop. 2015 Jun;35(4):403-6. doi: 10.1097/BPO.0000000000000277.


Background: Talipes equinovarus is the most common congenital lower limb abnormality. Decreased calf size has been found to have negative impacts on patients' subjective appraisals of long-term outcomes. This study compares calf circumference ratios in 2 groups of patients with unilateral clubfoot, those treated according to the Ponseti method and those treated with extensive surgery, to determine whether the current standard of care achieves better anatomic outcomes.

Methods: Patients >1 year after treatment for unilateral clubfoot were recruited during normal follow-up appointments and both calves were measured using a standardized protocol. A questionnaire concerning their treatment history was also completed. Data were analyzed by comparing calf circumference ratios between treatment modalities.

Results: Thirty-five patients with unilateral clubfoot were recruited after satisfying inclusion criteria. Twenty-four (69%) were included in the Ponseti-managed group, and 11 (31%) were in the extensive surgery group. The affected legs were on average 3% to 10% smaller than the control legs across all groups. The surgery group's average calf ratio was significantly less at 90.8%±3.5% compared with 94.4%±3.3% in the Ponseti group.

Conclusions: The calf circumference of limbs affected by clubfoot is significantly smaller in those treated with extensive surgery as compared with those treated with the Ponseti method alone, with or without percutaneous tenotomy. This supports the Ponseti method as the standard of care for achieving the most favorable anatomic outcome.

Level of evidence: Level I.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Body Size
  • Child, Preschool
  • Clubfoot* / diagnosis
  • Clubfoot* / surgery
  • Comparative Effectiveness Research
  • Female
  • Humans
  • Infant
  • Leg / pathology*
  • Male
  • Manipulation, Orthopedic* / adverse effects
  • Manipulation, Orthopedic* / methods
  • Manipulation, Orthopedic* / standards
  • Monitoring, Physiologic / methods
  • Orthopedic Procedures* / adverse effects
  • Orthopedic Procedures* / methods
  • Orthopedic Procedures* / standards
  • Orthotic Devices
  • Outcome Assessment, Health Care
  • Postoperative Complications / diagnosis*
  • Standard of Care