Dear Gabriel

This article may be useful for you:

J Pediatr Orthop B. 2015 Mar;24(2):143-6. 

Flexor digitorum accessorius longus muscle in resistant clubfoot patients: introduction of a new sign predicting its presence.

Shaheen S1, Mursal H, Rabih M, Johari A.

Abstract

Clubfoot, talipes equino varus (TEV), is a common congenital foot anomaly. Some cases are resistant to conservative treatment. Many causes of resistance have been reported, among these, the presence of anomalous muscles; however, the effect of the presence of anomalous muscles on the outcome of conservative management is not well studied. These aberrant muscles are discovered during the extensive surgical release as an abnormal finding. The aim of this work is to study the demographic characteristics of patients with resistant TEV that necessitated extensive soft tissue release at Sudan Clubfoot Clinic and to document the prevalence of flexor digitorum accessorius longus (FDAL) muscle in a large series of clubfoot patients treated by extensive surgery: posteromedial release. Also, we introduce a new observation as an indication by which the surgeon can predict the presence of FDAL. On the basis of an observation that there is a special posture of the big toe in extension in relation to other flexed toes associated with the presence of FDAL, records of patients of clubfoot treated by extensive surgery between 2007 and 2012 at the Sudan Clubfoot Project were reviewed. Demographic characteristics were studied. Only patients with idiopathic TEV were included. Resistant clubfeet necessitated extensive release in 261 patients, 197 males and 64 females. Their ages ranged between 1 day and 15 years at presentation. FDAL muscle was found in 48 patients (54 feet) out of 261 patients (411 feet, 13.14%). In 46 of the 48 patients (95.8%), the presence of the FDAL could be predicted by a sign. FDAL is prevalent in 13% of resistant TEV cases requiring extensive soft tissue release, and the surgeon can expect resistant clubfoot and predict the presence of the FDAL in over 95% before he operates by observing the Samir-Adam sign.

Hi Gabriel. I have treat clubfoot by Ponseti method  since 1993.  All the failures I saw was related to incomplete correction at the time of the last cast. Mainly the Impossibility to obtain external rotation close to 70 degrees. So, the foot at last cast has to be almost “perfect” corrected, also with at least 10% of dorsal flexion. Of course, some feet will need a release (around 5%) even with the best conservative care.

Hi,

I am using Ponseti method since 1992 and in majority of cases correction was obtain. In residual varus and adductus in children older than 2.5 yrs I have very good results with Transfer of tibialis anterior tendon. This op. prevents relapses and corrects the anteroposterior talocalcaneal angle and reduce necesity for posteromedial release.

if u did not achieve full correction at last cast don't hope correction at future also the deformity will increase  

It's happened more often in syndromic TEV, or idiopathic cases that start treatment late.

Thanks for your responses.

It is important to consider the possibility of significant spinal pathology early enough during conservative management or surgical intervention 

clubfoot in patients with NTD and skletal dysplasia is difficult to treat.

Although most of the residual deformities are not a real failure of treatment