PMID- 28178093 OWN - NLM STAT- MEDLINE DCOM- 20190125 LR - 20220409 IS - 1539-2570 (Electronic) IS - 0271-6798 (Linking) VI - 39 IP - 1 DP - 2019 Jan TI - Management of Clubfoot Relapses With the Ponseti Method: Results of a Survey of the POSNA Members. PG - 38-41 LID - 10.1097/BPO.0000000000000953 [doi] AB - BACKGROUND: Despite the high rate of initial success using the Ponseti method to manage idiopathic clubfoot deformity, relapse continues to be a problem. We surveyed the Pediatric Orthopedic Society of North America (POSNA) members about their experience with relapsed deformity following the initial correction of clubfeet. METHODS: We created a survey to focus on the management of clubfeet after initial correction of deformity. The survey included questions on postcorrective bracing, clinical findings used to identify relapse, the observed frequency of relapsed deformity, and how relapses are managed. The questionnaire was approved by the POSNA Evidence Based Committee and was sent electronically to all POSNA members. RESULTS: We received responses from 321 members (26%). Of those, 94% were fellowship trained in pediatric orthopaedics. The Ponseti method was used by 98% of respondents. The Mitchell-Ponseti orthosis was most commonly used (51%), followed by the Denis-Browne brace (25%). The duration of bracing used varied among members with 23% recommending only 2 years, 33% recommending 3 years, and 34% recommending 4 years. A tight heel cord was felt to be the first sign of relapse by 59% of respondents, and dynamic supination by 30%. The rate of relapse was observed to be <10% by 22% of the respondents, 10% to 20% by 52%, and 20% to 40% by 25%. Manipulation and cast treatment alone (55%) and cast treatment with tenotomy (23%) were reported as the 2 most common initial treatment approaches for a relapsed deformity. Cast treatment to correct relapsed deformity before tibialis anterior tendon transfer was reported by 62% of respondents. Heel cord tenotomy (75%) and posterior capsular release (43%) were the 2 most common procedures used in addition to tibialis anterior tendon transfer for the treatment of clubfoot relapse. CONCLUSION: This study highlights the wide variation with which clubfoot relapses are evaluated and treated among the POSNA membership with differences in the recommended duration of bracing, identification of relapses, and their management. These wide differences highlight the need for future research and educational programs to inform and standardize the management of clubfoot using the Ponseti Method. LEVEL OF EVIDENCE: Not applicable. FAU - Hosseinzadeh, Pooya AU - Hosseinzadeh P AD - Miami Orthopedics and Sports Medicine Institute, Baptist Children's Hospital. FAU - Kiebzak, Gary M AU - Kiebzak GM AD - Pediatric Orthopedic Center, Baptist Children's Hospital, Miami, FL. FAU - Dolan, Lori AU - Dolan L AD - Department of Orthopedics, University of Iowa, Iowa City, IA. FAU - Zionts, Lewis E AU - Zionts LE AD - Department of Orthopedics, David Geffen School of Medicine at UCLA, Los Angeles, CA. FAU - Morcuende, Jose AU - Morcuende J AD - Department of Orthopedics, University of Iowa, Iowa City, IA. LA - eng PT - Journal Article PL - United States TA - J Pediatr Orthop JT - Journal of pediatric orthopedics JID - 8109053 SB - IM MH - Achilles Tendon/surgery MH - Braces MH - *Casts, Surgical MH - Child MH - Child, Preschool MH - Clubfoot/*therapy MH - Combined Modality Therapy MH - Humans MH - Infant MH - *Manipulation, Orthopedic MH - Practice Patterns, Physicians' MH - Recurrence MH - Retreatment/methods MH - Surveys and Questionnaires MH - Tendon Transfer MH - *Tenotomy MH - Time Factors EDAT- 2017/02/09 06:00 MHDA- 2019/01/27 06:00 CRDT- 2017/02/09 06:00 PHST- 2017/02/09 06:00 [pubmed] PHST- 2019/01/27 06:00 [medline] PHST- 2017/02/09 06:00 [entrez] AID - 10.1097/BPO.0000000000000953 [doi] PST - ppublish SO - J Pediatr Orthop. 2019 Jan;39(1):38-41. doi: 10.1097/BPO.0000000000000953.