Midterm outcomes of complex clubfoot treated with the modified Ponseti method: A comparative study of primary and referred cases

Mehmet Ali Dolap; Ahmet Yiğit Kaptan; Turan Bal; Baki Volkan Çetin; Celal Bozkurt; Muhammed Işıkyıldız; Mehmet Akif Altay

doi:10.52312/jdrs.2026.2959

Mehmet Ali Dolap¹, Ahmet Yiğit Kaptan¹, Turan Bal², Baki Volkan Çetin¹, Celal Bozkurt³, Muhammed Işıkyıldız¹, Mehmet Akif Altay¹

¹Department of Orthopedics and Traumatology, Harran University Faculty of Medicine, Şanlıurfa, Türkiye
²Department of Orthopedics and Traumatology, Balıklıgöl State Hospital, Şanlıurfa, Türkiye
³Department of Orthopedics and Traumatology, Gaziosmanpaşa Training and Research Hospital, İstanbul, Türkiye

Keywords: Atypical clubfoot, complex clubfoot, modified Ponseti method.

Abstract

Objectives: This study aims to evaluate the midterm clinical outcomes of patients with complex clubfoot treated using the Ponseti method and to assess the sustainability of deformity correction over time.

Patients and methods: Between January 2016 and January 2021, a total of 38 feet in 26 patients with complex clubfoot treated using the modified Ponseti method were retrospectively analyzed. The patients were divided into two groups: those treated entirely in our institution (study center group) and those referred from external centers after unsuccessful initial treatment (external center group). Clinical severity was assessed using the Pirani score, and ankle dorsiflexion (DF) was measured during follow-up. Functional outcomes were evaluated using the Pirani-Based Score (PBS) and the Oxford Ankle Foot Questionnaire (OxAFQ). Relapse rates, additional procedures, and treatment success were analyzed. Independent predictors of outcomes were identified.

Results: Of a total of 26 patients included in the study, 2 were male and 24 were female with a mean age of 6.78±1.29 (range, 5 to 8) years. Of these patients, 14 (53.8%) had unilateral involvement, while 12 (46.2%) had bilateral deformity. The external clinic group presented at a significantly later age than the study center group (p < 0.001), while baseline deformity severity was comparable. Pirani scores and DF measurements improved significantly in both groups, with no intergroup differences during follow-up (p > 0.05). Functional outcomes showed a significant difference in PBS scores, which were higher in the external clinic group (p = 0.045), indicating worse functional performance, while the OxAFQ scores were similar between groups (p = 0.911). Relapse rates were higher in the own clinic group but did not reach statistical significance (p = 0.254). Multivariate analysis revealed that age was the only independent predictor of treatment success (odds ratio [OR] = 2.067, p = 0.019), while referral status was not an independent determinant.

Conclusion: The modified Ponseti method provides effective midterm correction in complex clubfoot regardless of referral status. Although referred patients present later and may demonstrate worse functional outcomes, referral source does not independently influence treatment success. Early recognition and appropriate application of modified Ponseti principles remain critical for optimal outcomes.

Citation: Dolap MA, Kaptan AY, Bal T, Çetin BV, Bozkurt C, Işıkyıldız M, et al. Midterm outcomes of complex clubfoot treated with the modified Ponseti method: A comparative study of primary and referred cases. Jt Dis Relat Surg 2026;37(3):873-881. doi: 10.52312/ jdrs.2026.2959.