الفهرس 
AcknowledgmentOnly 14 pages are availabe for public view
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Abstract
The clubfoot is one of the most common congenital anomalies. Being a complex deformity is the most important character in clubfoot. Hippocrates was the first to describe the corrective treatment of clubfoot and the fitting of bandages and corrective shoes (370 BC). Ponseti described his method in conservative treatment of clubfoot (1972). Regardless of the method of treatment, the clubfoot has a high tendency to relapse. Stiff and severe clubfeet are more prone to relapse than less severe feet. Relapses are rare after fouryears of age.(7)
The relapse is defined as appearance of one or more of the elements of the original deformity (equinus, varus, adductus and cavus) after complete primary correction. Hindfoot equinus and varus are the most common relapsing elements. Adductus and cavus are less common to relapse. Poor compliance with the abduction orthosis, loss of correction after surgery, postoperative soft tissue scarring and nature of the disease appear to be the main causes of the relapse.
The traditional methods of treatment of clubfoot relapse has some drawbacks including poor compliance with the external fixators, extensive soft tissue dissection which may lead to extensive post-operative scaring results in secondary relapse after correction of the initial relapse.
Fourty one feet in (37) patients of relapsed were examined in this study, only (19) feet (14 equinocavovarus and 5 cavovarus feet) were treated initially with Ponseti manipulation method while the other (22) feet (12 feet of equinus heel and the 10 feet of dynamic supination) were excluded from the step of Ponseti manipulation because the manual manipulation has no role in treatment of these deformities. The (19) feet which were treated with Ponseti manipulation required further surgical intervention to obtain complete correction. Minimal invasive surgical procedures were done according to the relapsing elements. The surgical procedures were selected according to the age of the patient and intra-operative assessment of the severity of deformity. Percutaneous Achilles tenotomy and limited posterior release were done for the feet showing equinus deformity. Limited medial and plantar release were done for the feet showing cavus and varus deformities. Tibialis anterior transfer and percutaneous tibialis anterior tenotomy were done for the feet showing dynamic supination deformity.
This protocol of the treatment of relapsed clubfoot using selected minimal invasive surgical procedures attacking each deformity shows some advantages including small wounds, minimal soft tissue dissection, less operative time and less incidence of infection.
from this study, we conclude that that this protocol can be reliable and can achieve comparable results to traditional methods of treatmnet but with fewer incidences of complications, less time of treatment and fewer costs.