Algorithm for Neglected Clubfoot and Residual Deformities Following Treatment
A neglected or untreated clubfoot is a common problem in resource-poor environments. While the pathoanatomy is the same as in patients treated as infants, the treatment becomes more complex with advancing age due to the severity of soft tissue contractures and limited bony remodeling potential. Ponseti management programs have been introduced in more than 100 countries, and surgical treatment for clubfoot is practiced to some extent in most environments, making it reasonable that a surgeon will encounter residual deformities in patients treated previously and must be aware of the specific pathology and the various techniques—alone or in combination—to correct the presenting deformity. The challenges are heightened for patients who do not have access to the treatment facility that allows long-term serial casting, surgical interventions, and follow-up necessary to achieve a plantigrade foot.
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