Correction of Arthrogrypotic Clubfoot Deformities with the Ponseti Method of Serial Casting

A 9 year old girl with arthrogryposis multiplex congenita was adopted from China with bilateral clubfoot deformities and severe relapses following prior posterior medial releases. She had 30–40° equinus contractures, with moderate to severe heel varus, and >45° supination and adductus and was wheelchair dependent. She was successfully treated with a modified Ponseti technique of serial casting. The modifications included an earlier percutaneous Achilles tenotomy, generalizing pressure over the anterolateral ankle rather than over just the lateral head of the talus, and specialized posttreatment AFOs, to slow the possibility of relapse.