To evaluate the effectiveness of a casting method for the early treatment of clubfoot deformity, a scoring system utilizing the French [DiMeglio], English [Pirani], and our functional rating system before and after each casting session was used to determine the final assessment and results of the Iowa [Ponseti] clubfoot technique.

Between Jan 2000 to June 2001, 49 clubfeet in 33 patients were assessed before and after the Ponseti casting at a minimum of 1 year follow up using the Dimeglio/ Bensahel, Hospital for Joint Diseases functional rating, and Catterall/Pirani scoring system. Mean age of presentation was 7 weeks [range 0.5 to 28 weeks]. Patients had casting +/− percutaneous TAL. At latest follow up patients who were compliant for Foot Abduction Orthosis [n=32 feet] had good results without any deterioration in their scores. Of the noncompliant patients 8 patients remained good. Of the nine feet that had poor results, 5 improved with recasting, 2 required percutaneous TAL and 2 required open TAL and posterior release.

Early treatment of the idiopathic clubfoot with serial [Ponseti] casting will be effective in over 90% of cases and patients will require no other treatment except for percutaneous tenotomy of the Achilles tendon.

Early use of the Iowa [Ponseti] technique [before the age of one year] will significantly reduce the current number of extensive surgical procedures performed for the treatment of clubfoot. Moreover, it will produce more flexible and supple feet and avoid the problem of stiff, recurrent post-surgical clubfoot.

Purpose: To describe a simple method for performing pelvic osteotomies in children that will obtain appropriate femoral head coverage.

Method: The necessary femoral head coverage was preoperatively predicted by assessing the acetabular, Wiberg, and Lequesne angles, and by 3-D CAT scan evaluations of each hip. Postoperative results were evaluated in a similar manner and compared with the preoperative findings. An “almost” percutaneous triple pelvic osteotomy was performed using an adductor incision and a transverse incision.

Results: In spite of the theoretical restrictions in this age group to acetabular movement, i.e. rigid triradiate cartilage, stiff symphysis pubis and rigid sacrospinous and sacrotuberous ligaments, adequate coverage of the femoral head was attained with the described technique.

Conclusion: If a pelvic osteotomy is being considered to better stabilize a child’s hip due to a condition such as Legg-Calve-Perthes disease, hip dysplasia, a deformed femoral neck secondary to slipped capital femoral epiphysis or femoral head necrosis, the “almost” percutaneous triple osteotomy has a decided advantage over other well described pelvic osteotomies since it is simpler to perform and sufficiently covers the femoral head.