Pes equinovarus:New Treatment Strategies and Pathogenetic Mechanisms

Idiopathic pes equinovarus (also referred to as clubfoot) is a congenital deformity of the foot and lower leg; it has five components: equinus, varus, adductus, cavus and supination of the foot. At present two principle methods are mostly used for the treatment of clubfoot: physiotherapy and continuous motion without immobilization and the Ponseti method (serial manipulation, cast application, Achilles tenotomy and transposition of m. tibilalis ant.). This method has been reported to have short-term success rates approaching 100%, and the long-term results have been equally impressive. We believe, however, that the data on the success rate may be significantly influenced by the duration of the period after termination of the treatment. The purpose of the first part of our study was, therefore, to compare the short-term (up to three years) and long-term (three to seven years) results of treatment of idiopathic clubfeet with the Ponseti method and to determine the factors for recurrence. We have tested the hypothesis whether is it possible to cure all clubfeet with the Ponseti method only. We have found significant difference between the evaluation of the short- term and long-term results: the number of relapses during the first three years of treatment, indicated for surgical intervention, was..