Prognosis

Long-term studies demonstrate good to excellent results using non-operative bracing and serial casting (with the Ponseti method) and poorer results with surgical methods.[12]​[13][14][15][29][31]​​[49][50] Without treatment, results are uniformly poor, with affected children walking on the dorsum of their feet.

Natural history

The child with an untreated clubfoot begins to walk on the dorsum of the foot. A large callus develops in this region. Painful arthritic changes will continue to develop, leading to a painful deformed foot. In resource-poor settings, people with neglected clubfoot have been described as "condemned to the downward spiral of deformity, disability, dependency, demoralisation, depression, and despair".[44][Figure caption and citation for the preceding image starts]: Untreated clubfoot in an adolescentFrom the collection of Scott E. Van Valin [Citation ends].com.bmj.content.model.Caption@1b72ce00

Ponseti method

Excellent results have been obtained. A 30-year follow-up demonstrated that 78% of Ponseti-treated clubfeet had excellent or good results using pain and functional limitations as outcome criteria. This compares with 85% of a group of people with similar results that did not have clubfoot deformities.[49]

Surgical treatment

Surgery gives good function in the first 2 decades of life; later in life, function is poorer. Many patients require repeated surgery, which decreases foot function and quality of life in later years.​[12]​

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