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The patient's plain radiographs before treatment.
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Clinically, both her feet were grossly deformed and stiff with forefoot adduction, midfoot cavus, hindfoot varus and rigid equinus (Figure 1).
(A) Bilateral untreated clubfoot seen anteriorly; weightbearing on talus prominences and dorsum of the forefeet. (B) The same clubfoot seen from posterior in standing position; both feet adducted and supinated with equinus deformity.
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She had adapted to walking short distances on the talar heads and the dorsum of her forefoot, resulting in callus formation over the dorsum of both talar prominences (Figure 2A and B).
Sitting on the floor in long leg casts; she was able to move across the room despite the casts.
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Following this, a roll of 4-inch fiberglass cast was applied for cast longevity, as we expected her to move for wheelchair transfers, and bottom shuffling on the floor (Figures 3 and 4).
Long-leg bent-knee cast was convenient for wheelchair mobilization and car rides.
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Following this, a roll of 4-inch fiberglass cast was applied for cast longevity, as we expected her to move for wheelchair transfers, and bottom shuffling on the floor (Figures 3 and 4).
Repeat radiographs prior to posterior ankle release showing improved forefoot abduction.
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We found we could achieve only few degrees of abduction within the patient's tolerance each week and the best final abduction at week 9 was at 30  with the head of talus satisfactorily covered and the heels in neutral (Figure 5).
Alignment of the feet at the conclusion of casting showing marked improvement and dried callosity over the dorsolateral aspect.
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She had a Z-lengthening of both Achilles tendons with posterior tibio-talar and subtalar capsulotomy to achieve 15  dorsiflexion and was then immobilized in these knee casts for six weeks to allow healing of the Achilles tendon (with wound checks at three weeks and re-casting) (Figure 6).
Foot abduction brace.
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We applied foot abduction brace (Figure 7) for night-time and recommended regular shoes in the daytime.
Twelve months post Ponseti treatment with independent walking on uneven earth terrain.
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By electronic communication with her carers, we discovered she was able to walk to school on uneven terrain (pebbled, mud path) six months after seeing us, and even participated in her school dance performance six months thereafter (Figures 8 and 9).
Near normal looking feet and no recurrence of clubfoot at twelve months; previous callosity had resolved with neutral to mild valgus heels.
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By electronic communication with her carers, we discovered she was able to walk to school on uneven terrain (pebbled, mud path) six months after seeing us, and even participated in her school dance performance six months thereafter (Figures 8 and 9).
Weight-bearing views of both ankles at eighteen months with good function and painless ambulation.
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At eighteen months post-treatment, she had picked up bicycle riding and was walking barefoot with no discomfort or pain in her feet and ankles, despite her radiographs (Figure 10).