{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:26:41Z","timestamp":1787754401887,"version":"build-2784847793"},"reference-count":49,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"20","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery"],"published-print":{"date-parts":[[2016,10,19]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>There is no established treatment for rigid residual deformity of congenital clubfoot (CCF) after walking age. Soft-tissue procedures, osseous procedures, and external fixation have been performed with unpredictable results. We applied the Ponseti method to patients with this condition in order to improve the outcomes of treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We retrospectively reviewed the cases of 44 patients (68 feet) with congenital clubfoot whose mean age (and standard deviation) at treatment was 4.8 \u00b1 1.6 years. All patients had been previously treated in other institutions by various conservative and surgical protocols. Residual deformity was evaluated using the International Clubfoot Study Group Score (ICFSGS), and stiffness was rated by the number of casts needed for deformity correction. Ponseti manipulation and cast application was performed. Equinus was usually treated with percutaneous heel-cord surgery, while the cavus deformity was treated with percutaneous fasciotomy when needed. Tibialis anterior tendon transfer (TATT) was performed in patients over 3 years old. At the time of follow-up, the results were evaluated using the ICFSGS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Before treatment, 12 feet were graded as fair and 56, as poor. Two to 4 casts were applied, with each cast worn for 4 weeks. Stiffness was moderate (2 casts) in 23 feet, severe (3 casts) in 30 feet, and very severe (4 casts) in 15 feet. Percutaneous heel-cord surgery was performed in 28 feet; open posterior release, in 5 feet; plantar fasciotomy, in 30 feet; and TATT, in 60 feet. The mean length of follow-up was 4.9 \u00b1 1.8 years. Eight feet had an excellent result; 49 feet, a good result; and 11 feet, a fair result. No patient had pain. All of the feet showed significant improvement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Ponseti treatment with TATT, which was performed in 88% of the feet, was effective, and satisfactory results were achieved in 84% of the feet. At the time of follow-up, no patient showed an abnormal gait, all feet were plantigrade and flexible, but 2 feet (2.9%) had relapsed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level IV<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.16.00053","type":"journal-article","created":{"date-parts":[[2016,10,19]],"date-time":"2016-10-19T13:58:24Z","timestamp":1476885504000},"page":"1706-1712","source":"Crossref","is-referenced-by-count":12,"title":["Ponseti Treatment of Rigid Residual Deformity in Congenital Clubfoot After Walking Age"],"prefix":"10.2106","volume":"98","author":[{"given":"Massimiliano","family":"Dragoni","sequence":"first","affiliation":[{"name":"Departments of Clinical Science and Translational Medicine (M.D. and G.V.) and Orthopaedics and Traumatology (P.F., D.B., and E.I.), University of Rome \u201cTor Vergata,\u201d Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pasquale","family":"Farsetti","sequence":"additional","affiliation":[{"name":"Departments of Clinical Science and Translational Medicine (M.D. and G.V.) and Orthopaedics and Traumatology (P.F., D.B., and E.I.), University of Rome \u201cTor Vergata,\u201d Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Vena","sequence":"additional","affiliation":[{"name":"Departments of Clinical Science and Translational Medicine (M.D. and G.V.) and Orthopaedics and Traumatology (P.F., D.B., and E.I.), University of Rome \u201cTor Vergata,\u201d Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego","family":"Bellini","sequence":"additional","affiliation":[{"name":"Departments of Clinical Science and Translational Medicine (M.D. and G.V.) and Orthopaedics and Traumatology (P.F., D.B., and E.I.), University of Rome \u201cTor Vergata,\u201d Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pierluigi","family":"Maglione","sequence":"additional","affiliation":[{"name":"Orthopaedic Unit, Department of Surgery and Transplant Center, Bambino Ges\u00f9 Children\u2019s Hospital, Fiumicino, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ernesto","family":"Ippolito","sequence":"additional","affiliation":[{"name":"Departments of Clinical Science and Translational Medicine (M.D. and G.V.) and Orthopaedics and Traumatology (P.F., D.B., and E.I.), University of Rome \u201cTor Vergata,\u201d Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"issue":"8","key":"bib1-20230714","doi-asserted-by":"crossref","first-page":"486","DOI":"10.5435\/00124635-201008000-00005","article-title":"Bracing following correction of idiopathic clubfoot using the Ponseti method","volume":"18","author":"Zionts","year":"2010","journal-title":"J Am Acad Orthop Surg."},{"issue":"2","key":"bib2-20230714","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/j.fcl.2010.01.003","article-title":"Residual clubfoot in children","volume":"15","author":"Uglow","year":"2010","journal-title":"Foot 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Orthop."},{"issue":"2","key":"bib6-20230714","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1097\/01241398-199203000-00011","article-title":"Analysis of the components of residual deformity in clubfeet presenting for reoperation","volume":"12","author":"Tarraf","year":"1992","journal-title":"J Pediatr Orthop."},{"issue":"11","key":"bib7-20230714","doi-asserted-by":"crossref","first-page":"1526","DOI":"10.1302\/0301-620X.91B11.22327","article-title":"Selective soft-tissue release for recurrent or residual deformity after conservative treatment of idiopathic clubfoot","volume":"91","author":"Park","year":"2009","journal-title":"J Bone Joint Surg Br."},{"issue":"7","key":"bib8-20230714","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1302\/0301-620X.91B7.22474","article-title":"Recurrent club-foot deformity following previous soft-tissue release: mid-term outcome after revision surgery","volume":"91","author":"Mehrafshan","year":"2009","journal-title":"J Bone Joint 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Orthop."},{"issue":"2","key":"bib37-20230714","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1007\/s11999-013-3287-x","article-title":"Is tibialis anterior tendon transfer effective for recurrent clubfoot?","volume":"472","author":"Gray","year":"2014","journal-title":"Clin Orthop Relat Res."},{"key":"bib38-20230714","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1097\/01.blo.0000201147.12292.6b","article-title":"Ponseti management of clubfoot in older infants","volume":"444","author":"Bor","year":"2006","journal-title":"Clin Orthop Relat Res."},{"issue":"1","key":"bib39-20230714","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1097\/BPB.0b013e328347a329","article-title":"Management of idiopathic clubfoot in toddlers by Ponseti\u2019s method","volume":"21","author":"Verma","year":"2012","journal-title":"J Pediatr Orthop B."},{"issue":"3","key":"bib40-20230714","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1302\/0301-620X.89B3.18313","article-title":"Correction of neglected idiopathic club foot by the Ponseti method","volume":"89","author":"Louren\u00e7o","year":"2007","journal-title":"J Bone Joint Surg Br."},{"issue":"5","key":"bib41-20230714","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1097\/BPB.0b013e3283387cc8","article-title":"Ponseti\u2019s manipulation in neglected clubfoot in children more than 7 years of age: a prospective evaluation of 25 feet with long-term follow-up","volume":"19","author":"Khan","year":"2010","journal-title":"J Pediatr Orthop B."},{"issue":"1","key":"bib42-20230714","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1111\/j.1442-200X.2010.03201.x","article-title":"Ponseti management of clubfoot after walking age","volume":"53","author":"Yagmurlu","year":"2011","journal-title":"Pediatr 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degradation in rat tissues. Importance of degradation of newly synthesized collagen in regulating collagen production","volume":"276","author":"Mays","year":"1991","journal-title":"Biochem J."},{"issue":"5","key":"bib50-20230714","doi-asserted-by":"crossref","first-page":"652","DOI":"10.2106\/00004623-198264050-00002","article-title":"Surgical management of resistant congenital talipes equinovarus deformities","volume":"64","author":"Thompson","year":"1982","journal-title":"J Bone Joint Surg Am."},{"issue":"6","key":"bib51-20230714","doi-asserted-by":"crossref","first-page":"770","DOI":"10.1097\/01241398-199811000-00014","article-title":"Rotatory dorsal subluxation of the navicular: a complication of clubfoot surgery","volume":"18","author":"Kuo","year":"1998","journal-title":"J Pediatr Orthop."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/00004623-201610190-00004","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:26:55Z","timestamp":1787750815000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/00004623-201610190-00004"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,10,19]]},"references-count":49,"journal-issue":{"issue":"20","published-print":{"date-parts":[[2016]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.16.00053","relation":{"has-review":[{"id-type":"doi","id":"10.3410\/f.726994649.793525599","asserted-by":"object"}]},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,10,19]]}}}