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After months and months in casts and braces for a clubfoot deformity, our pretty baby went off to kindergarten looking healthy and whole. Now a year later, I think that foot is slipping back into its old clubfoot position. Is that possible?

Yes, relapse deformities even after successful clubfoot treatment are possible. In fact, there have been enough reports of this happening that surgeons are taking a second look. It is important to find out if there's any way to prevent this from occurring. The first step is to follow children long enough to report cases of recurrence. Then risk factors can be identified and a plan put in place for both prevention and successful treatment of the relapsed condition. A recent study from the Ponseti Center for Clubfoot Treatment at the University of Iowa has gotten a start on gathering this type of information. Thirty-nine (39) children with relapsing clubfoot were included in the study. Some children had both feet affected so the total number of clubfeet was 60. All the children had been treated at this Ponseti center from early on (some as early as three days after birth, others later but before age two). Everyone was prescribed the required abduction brace, which was supposed to be used up until age four. There were differences in the timing of relapse among the children. Some lost the initial correction early on while others didn't relapse until much later after treatment. By studying what happened to the children with later relapses, the authors were able to identify some trends that might help guide prevention and treatment for other children affected by this problem in the future. Treatment for late-relapses also varied and ranged from 1) observation only to 2) bracing, or 3) casting followed by bracing, 4) casting to prepare the feet for surgery followed by surgery then bracing, and 5) surgery. Most of the children (no matter how they were treated for the relapse) ended up having surgery to correct the deformity. The most common surgical procedure was a tendon transfer called TATT for tibialis anterior tendon transfer. Continued follow-up of these children showed that almost all of them could wear normal shoes. Some of the children were limited in what they could do as they got older because of their feet. Complaints of pain with activity or aching at the end of the day were reported by 44 per cent of the group. The authors present these findings to help identify the prevalence of late relapse after successful treatment of clubfoot deformities in children using the Ponseti method. Although the Ponseti method seems to be successful early on, children should be followed routinely to recognize early signs of relapse. We know that relapses don't recover on their own without intervention. If you are noticing change in the affected foot, make an appointment with your surgeon right away. Follow-up treatment may be needed. Research is needed to determine the best treatment for late relapses and to identify risk factors for relapse. Currently, poor compliance with abduction bracing is the only known risk factor. Changes in the brace angle and wearing schedule have already been implemented, which may account for the decline in relapse rates from even 10 years ago.

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