Relapse is when the corrected normal-looking treated foot starts bending back to the clubfoot position. Relapse happens gradually and the doctors must identify it at the initial stage and start treating it as soon as possible. The reason for relapse is the non-compliance by the parents. They fail to brace the child and the foot that is left without abduction goes to the original clubfoot position.
Relapse is identified by doctors who carefully record the Pirani score during every follow-up visit. The doctors must look at the foot carefully and record each of the six Pirani scores to ensure that the score remains zero. In case the score is even 0.5 instead of zero, the area that has relapsed should be immediately addressed. There are chances that the rigidity of the equines is coming back or the lateral curved border is showing some points in the Pirani score.
The way to correct relapse is to start casting until the Pirani score goes to zero. If there is a relapse in the rigidity of equines, the only way to correct is to redo the tenotomy. Doctors ask if a tenotomy could be performed again. The answer is yes. The time between the first tenotomy and the second or redo tenotomy should be at least six to eight weeks or more. The point to insert the blade to cut the tendon also should be carefully decided. The redone tenotomy regenerates as well as the first tenotomy.
The point is, if there are any compromises in bracing there will be a relapse and if there is a relapse, it has to be identified early and the treatment has to begin without any delay. The relapsed foot can be very well corrected by the Ponseti method irrespective of the age of the child. The point is to score every time the child comes to the clinic/hospital for follow-up and if there is a change in the Pirani score start treatment sooner.
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