In a child under 2 years with recurrent clubfoot after Ponseti method, what is the recommended treatment?

In a child under 2 years with recurrent clubfoot after Ponseti method, what is the recommended treatment?

• A. Repeat the same treatment
• B. Osteotomy
• C. Tenotomy only
• D. Arthrodesis

Answer: (A)

Recurrent clubfoot in a child under two after Ponseti is best managed by reapplying the Ponseti casting process. The foot deformity in this age group often relapses due to growth and soft-tissue elasticity, and redoing the serial casts allows gentle, gradual realignment while the child’s bones and ligaments adapt with growth. This approach preserves future growth potential and avoids more invasive surgery unless nonoperative methods fail.

In practice, this means reassessing the relapse, redoing the gentle manipulations, applying a new series of casts with weekly changes, and addressing any remaining equinus with a tenotomy as part of the recast if needed. Osteotomy or arthrodesis are far more invasive and typically reserved for older children or rigid deformities that do not respond to casting. Tenotomy alone would not correct all components of the relapse unless it’s needed within the recasting sequence.