Sixty Years On: Ponseti Method for Clubfoot Treatment Produces High Satisfaction Despite Inherent Tendency to Relapse

J Bone Joint Surg Am. 2018 May 2;100(9):721-728. doi: 10.2106/JBJS.17.01024.


Background: Developed at the University of Iowa in 1950, the Ponseti method to manage idiopathic clubfoot deformity was slow to gain wide acceptance until the mid-1990s. There is a paucity of intermediate and long-term outcome studies involving this technique, with nearly all such studies coming from a single institution. The purpose of this study is to report the contemporary outcome of patients with clubfoot deformity whose feet were managed with the Ponseti method and who were followed to ≥5 years old, to provide outcome expectations for parents and for clinicians managing patients with idiopathic clubfoot.

Methods: Families of infants seen in our clinic diagnosed with idiopathic clubfoot since July 2006 were prospectively invited to participate in our institutional review board-approved study. Patients who received no prior outside treatment and had a minimum follow-up to the age of 5 years were included. Demographic, treatment, and outcome data were collected. To provide an array of outcome measures, both the Dallas outcome criteria and the Roye disease-specific instrument (DSI) were used.

Results: One hundred and one patients met the inclusion criteria. The mean length of follow-up (and standard deviation) was 81.1 ± 17.1 months. Initial correction was achieved in all feet. Thirty-seven percent of families reported that they were adherent with the bracing protocol; 68% of patients had ≥1 relapse, and 38% underwent a tendon transfer. With the Dallas criteria, 62% had outcomes rated as good, 38% had outcomes rated as fair, and no patient had an outcome rated as poor. With the Roye DSI, most families were generally very satisfied with the function and appearance of the feet.

Conclusions: Satisfactory results at intermediate follow-up were achieved using the Ponseti method. However, despite a better understanding of the Ponseti method and the importance of longer post-corrective brace use, the need for anterior tibial tendon transfer remains an important adjunct to the Ponseti method. Brace adherence also continues to be a critical clinical issue.

Level of evidence: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

MeSH terms

  • Braces*
  • Casts, Surgical*
  • Child, Preschool
  • Clubfoot / therapy*
  • Female
  • Humans
  • Infant
  • Male
  • Manipulation, Orthopedic / methods*
  • Prospective Studies
  • Recurrence
  • Tendon Transfer
  • Tenotomy
  • Treatment Outcome