{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T15:28:59Z","timestamp":1787671739074,"version":"build-2736575974"},"reference-count":26,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"7","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Am Acad Orthop Surg","JAAOS"],"published-print":{"date-parts":[[2017,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The timing and relevance of relapsed deformity after correction of idiopathic clubfoot have not been well documented.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>All patients with idiopathic clubfoot seen at the authors\u2019 institution during the study period who were followed for \u22652 years (range, 2.0 to 9.8 years) were included (N = 191). Survival analysis and multivariate regression analysis were used to analyze the data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The median age at first relapse was 20 months. The probability of relapse remained approximately 30% at age 2 years and increased to 45% by 4 years and 52% by 6 years. Parent-reported adherence with bracing reduced the odds of a relapse by 15 times (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.01). After an initial relapse, adherence with bracing was successful in avoiding a subsequent relapse in 68% of patients. Feet graded as very severe on the Dim\u00e9glio scale were 5.75 times more likely to relapse than those graded severe and were 7.27 times more likely than those graded as moderate.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion:<\/jats:title>\n                    <jats:p>Patients whose parents reported nonadherence with bracing and patients with very severe deformities were most likely to relapse. After an initial relapse, regaining correction of the foot and resuming bracing were beneficial to avoid further relapses. These findings can be useful to clinicians in advising families regarding the prognosis of treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The development of a relapse affects the subsequent management and outcome of clubfoot deformity. The importance of bracing should be reinforced to parents. Bracing until at least age 4 years may be beneficial. For patients whose families are especially resistant to brace use and for older patients who experience a second relapse, regaining correction of the deformity via cast treatment followed by an Achilles lengthening procedure and\/or tendon transfer may be the best alternative.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.5435\/jaaos-d-16-00522","type":"journal-article","created":{"date-parts":[[2017,6,2]],"date-time":"2017-06-02T14:13:44Z","timestamp":1496412824000},"page":"536-545","source":"Crossref","is-referenced-by-count":39,"title":["The Timing and Relevance of Relapsed Deformity in Patients With Idiopathic Clubfoot"],"prefix":"10.5435","volume":"25","author":[{"given":"Sophia Nicole","family":"Sangiorgio","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward","family":"Ebramzadeh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca D.","family":"Morgan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lewis E.","family":"Zionts","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"issue":"2","key":"R2-20230714","doi-asserted-by":"crossref","first-page":"261","DOI":"10.2106\/00004623-196345020-00004","article-title":"Congenital club foot: The results of treatment","volume":"45","author":"Ponseti","year":"1963","journal-title":"J Bone Joint Surg Am"},{"issue":"5","key":"R3-20230714","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1097\/BPO.0b013e318259ff79","article-title":"The current management of idiopathic clubfoot revisited: Results of a survey of the POSNA membership","volume":"32","author":"Zionts","year":"2012","journal-title":"J Pediatr Orthop"},{"issue":"3","key":"R4-20230714","doi-asserted-by":"crossref","first-page":"530","DOI":"10.2106\/JBJS.H.00580","article-title":"Effect of cultural factors on outcome of Ponseti treatment of clubfeet in rural America","volume":"91","author":"Avilucea","year":"2009","journal-title":"J Bone Joint Surg Am"},{"issue":"1","key":"R5-20230714","doi-asserted-by":"crossref","first-page":"22","DOI":"10.2106\/00004623-200401000-00005","article-title":"Factors predictive of outcome after use of the Ponseti method for the treatment of idiopathic clubfeet","volume":"86","author":"Dobbs","year":"2004","journal-title":"J Bone Joint Surg Am"},{"issue":"1","key":"R6-20230714","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1007\/s00402-005-0070-9","article-title":"Ponseti technique for the correction of idiopathic clubfeet presenting up to 1 year of age: A preliminary study in children with untreated or complex deformities","volume":"126","author":"G\u00f6ksan","year":"2006","journal-title":"Arch Orthop Trauma Surg"},{"issue":"3","key":"R7-20230714","doi-asserted-by":"crossref","first-page":"487","DOI":"10.2106\/JBJS.F.00169","article-title":"Early clubfoot recurrence after use of the Ponseti method in a New Zealand population","volume":"89","author":"Haft","year":"2007","journal-title":"J Bone Joint Surg Am"},{"issue":"7","key":"R8-20230714","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1097\/BPO.0b013e3182694f4d","article-title":"Treatment of idiopathic clubfoot: Experience with the Mitchell-Ponseti brace","volume":"32","author":"Zionts","year":"2012","journal-title":"J Pediatr Orthop"},{"issue":"1","key":"R9-20230714","doi-asserted-by":"crossref","first-page":"23","DOI":"10.2106\/00004623-198062010-00004","article-title":"Long-term results of treatment of congenital club foot","volume":"62","author":"Laaveg","year":"1980","journal-title":"J Bone Joint Surg Am"},{"issue":"11","key":"R10-20230714","doi-asserted-by":"crossref","first-page":"2313","DOI":"10.2106\/JBJS.G.01621","article-title":"A comparison of two nonoperative methods of idiopathic clubfoot correction: The Ponseti method and the French functional (physiotherapy) method","volume":"90","author":"Richards","year":"2008","journal-title":"J Bone Joint Surg Am"},{"issue":"2","key":"R11-20230714","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1097\/01202412-199504020-00002","article-title":"Classification of clubfoot","volume":"4","author":"Dim\u00e9glio","year":"1995","journal-title":"J Pediatr Orthop B"},{"issue":"3","key":"R12-20230714","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1097\/01241398-199805000-00010","article-title":"An independent assessment of two clubfoot-classification systems","volume":"18","author":"Flynn","year":"1998","journal-title":"J Pediatr Orthop"},{"issue":"1","key":"R13-20230714","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1097\/BPO.0b013e3182670361","article-title":"Achievement of gross motor milestones in children with idiopathic clubfoot treated with the Ponseti method","volume":"33","author":"Sala","year":"2013","journal-title":"J Pediatr Orthop"},{"issue":"19","key":"R14-20230714","doi-asserted-by":"crossref","first-page":"e164","DOI":"10.2106\/JBJS.M.01525","article-title":"Walking age of infants with idiopathic clubfoot treated using the Ponseti method","volume":"96","author":"Zionts","year":"2014","journal-title":"J Bone Joint Surg Am"},{"issue":"2","key":"R15-20230714","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1097\/BPB.0b013e32801048bb","article-title":"Treatment of idiopathic clubfoot using the Ponseti method: Minimum 2-year follow-up","volume":"16","author":"Abdelgawad","year":"2007","journal-title":"J Pediatr Orthop B"},{"issue":"5","key":"R16-20230714","doi-asserted-by":"crossref","first-page":"1263","DOI":"10.1007\/s11999-008-0683-8","article-title":"Ponseti treatment for idiopathic clubfoot: Minimum 5-year followup","volume":"467","author":"Bor","year":"2009","journal-title":"Clin Orthop Relat Res"},{"issue":"10","key":"R17-20230714","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1302\/0301-620X.88B10.17578","article-title":"Treatment of idiopathic club foot using the Ponseti method: Initial experience","volume":"88","author":"Changulani","year":"2006","journal-title":"J Bone Joint Surg Br"},{"issue":"5","key":"R18-20230714","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/S1067-2516(03)00312-0","article-title":"Evaluation of the treatment of idiopathic clubfoot by using the Ponseti method","volume":"42","author":"Colburn","year":"2003","journal-title":"J Foot Ankle Surg"},{"issue":"5","key":"R19-20230714","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1097\/BPB.0b013e32826d18a6","article-title":"Comparative results of the conservative treatment in clubfoot by two different protocols","volume":"16","author":"Cosma","year":"2007","journal-title":"J Pediatr Orthop B"},{"issue":"5","key":"R20-20230714","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.2106\/JBJS.H.00178","article-title":"Comparison of surgeon and physiotherapist-directed Ponseti treatment of idiopathic clubfoot","volume":"91","author":"Janicki","year":"2009","journal-title":"J Bone Joint Surg Am"},{"issue":"2","key":"R21-20230714","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1542\/peds.113.2.376","article-title":"Radical reduction in the rate of extensive corrective surgery for clubfoot using the Ponseti method","volume":"113","author":"Morcuende","year":"2004","journal-title":"Pediatrics"},{"key":"R22-20230714","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/1749-799X-6-3","article-title":"Mid-term results of Ponseti method for the treatment of congenital idiopathic clubfoot\u2014(a study of 67 clubfeet with mean five year follow-up)","volume":"6","author":"Porecha","year":"2011","journal-title":"J Orthop Surg Res"},{"issue":"9","key":"R23-20230714","doi-asserted-by":"crossref","first-page":"1827","DOI":"10.1007\/s00264-013-2029-8","article-title":"Midterm results of the Ponseti method in the treatment of congenital clubfoot","volume":"37","author":"Radler","year":"2013","journal-title":"Int Orthop"},{"issue":"6","key":"R24-20230714","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1097\/BPO.0b013e318221eaa1","article-title":"Orthosis noncompliance after the Ponseti method for the treatment of idiopathic clubfeet: A relevant problem that needs reevaluation","volume":"31","author":"Ram\u00edrez","year":"2011","journal-title":"J Pediatr Orthop"},{"issue":"8","key":"R25-20230714","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1302\/0301-620X.88B8.17919","article-title":"Early results of a physiotherapist-delivered Ponseti service for the management of idiopathic congenital talipes equinovarus foot deformity","volume":"88","author":"Shack","year":"2006","journal-title":"J Bone Joint Surg Br"},{"issue":"2","key":"R26-20230714","doi-asserted-by":"crossref","first-page":"213","DOI":"10.3109\/17453674.2013.784659","article-title":"Predictive factors for residual equinovarus deformity following Ponseti treatment and percutaneous Achilles tenotomy for idiopathic clubfoot: A retrospective review of 50 cases followed for median 2 years","volume":"84","author":"Noh","year":"2013","journal-title":"Acta Orthop"},{"issue":"1","key":"R27-20230714","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1097\/BPB.0b013e32834c31a2","article-title":"Initial severity rating of idiopathic clubfeet is an outcome predictor at age two years","volume":"21","author":"Zhang","year":"2012","journal-title":"J Pediatr Orthop B"}],"container-title":["Journal of the American Academy of Orthopaedic Surgeons"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/00124635-201707000-00008","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T14:47:58Z","timestamp":1787669278000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/00124635-201707000-00008"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,7]]},"references-count":26,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2017]]}},"URL":"https:\/\/doi.org\/10.5435\/jaaos-d-16-00522","relation":{},"ISSN":["1067-151X","1940-5480"],"issn-type":[{"value":"1067-151X","type":"print"},{"value":"1940-5480","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,7]]}}}