The Ponseti method of
clubfoot management requires a period of bracing in order to maintain correction. This study compared the effectiveness of ankle
foot orthoses and Denis Browne boots and bar in the prevention of recurrence following successful initial management. Between 2001 and 2003, 45 children (69 feet) with idiopathic
clubfeet achieved full correction following Ponseti casting with or without a
tenotomy, of whom 17 (30
clubfeet) were braced with an ankle
foot orthosis while 28 (39
clubfeet) were prescribed with Denis Browne boots and bar. The groups were similar in age, gender, number of casts and
tenotomy rates. The mean follow-up was 60 months (50 to 72) in the ankle
foot orthosis group and 47 months (36 to 60) in the group with boots and bars. Recurrence requiring additional treatment occurred in 25 of 30 (83%) of the ankle
foot orthosis group and 12 of 39 (31%) of the group with boots and bars (p < 0.001). Additional procedures included repeat
tenotomy (four in the ankle
foot orthosis group and five in the group treated with boot and bars), limited posterior release with or without
tendon transfers (seven in the ankle
foot orthosis group and two in the group treated with boots and bars), posteromedial releases (nine in the
orthosis group) and midfoot
osteotomies (five in the
orthosis group, p < 0.001). Following initial correction by the Ponseti method, children managed with boots and bars had far fewer recurrences than those managed with ankle
foot orthoses. Foot abduction appears to be important to maintain correction of
clubfeet treated by the Ponseti method, and this cannot be achieved with an ankle
foot orthosis.