MANAGEMENT OF THE COMPLEX CLUBFOOT

Abstract

• Clubfoot is a congenital deformity which is seen once in 1000 live births; most often considered idiopathic, a certain number of patients may have an associated diagnosis. Clubfeet are best managed by the Ponseti method of manipulation and casting, and initially corrects the deformity in greater than 90 percent of idiopathic patients. Yet a certain percentage of these feet resist the Ponseti method and while undergoing the standard method develop characteristic features. Termed the "complex" clubfoot, these feet are often red, swollen, painful and have forefoot cavus with retraction of the great toe. When these occur, Ponseti recommended changing the strategy of correction. The purpose of this paper is to outline how we identify and manage the complex clubfoot.