In a child under 2 years with recurrent clubfoot after Ponseti method, what is the recommended treatment?

• A. Repeat the same treatment
• B. Osteotomy
• C. Tenotomy only
• D. Arthrodesis

Answer: (A)

When a child under two has a recurrence of clubfoot after Ponseti treatment, the best next step is to reapply the Ponseti technique with serial casting and then continue bracing to maintain correction. This age group typically has flexible soft tissues and growth potential, so a renewed series of casts can restore alignment without resorting to bone surgery. If ankle dorsiflexion remains limited after the renewed casting, a repeat Achilles tenotomy can be considered as part of the same treatment course, but addressing the whole relapse with casting is usually sufficient first. More invasive options like osteotomy or arthrodesis are reserved for rigid or nonresponsive cases, or older children, where nonoperative methods are unlikely to yield reliable results. Tenotomy alone generally cannot correct the full relapse of hindfoot and midfoot deformity when recurrence occurs after Ponseti.