Clubfoot recurrence: epidemiology, causes, and methods of correction

Background. Congenital clubfoot is one of the most common musculoskeletal deformities in children, occurring with a frequency of 0.6–1.5 cases per 1000 live births. Despite the high effectiveness of the Ponseti method, the recurrence rate reaches 40%, which represents a serious problem in pediatric orthopedics. Objective — to summarize and systematize current data on the epidemiology, risk factors for the development of congenital clubfoot and methods of correcting its recurrence. Materials and methods. A search and analysis of publications was conducted in the E-library and PubMed databases using the keywords "clubfoot recurrence", "clubfoot relapse" for the period 1964–2025. The descriptive review included 83 relevant clinical studies, reports and systematic reviews. Results. It was found that the prevalence of clubfoot varies depending on geographic region (from 0.51 to 2.03 per 1000 live births) and ethnicity. The recurrence rate after Ponseti method treatment is 10–30%, after surgical treatment — 20–50%. The leading risk factors for recurrence are: non-compliance with brace wearing protocol (increases risk by 5.4 times), high initial Pirani score, age at treatment initiation over 3 months, bilateral clubfoot. An algorithm for selecting the recurrence correction method is presented depending on the patient's age and nature of deformity: from repeated Ponseti casting to complex reconstructive interventions (tendon transpositions, osteotomies, arthrodeses). Conclusion. Clubfoot recurrences remain a relevant problem requiring a multidisciplinary approach. Key prevention factors are strict adherence to orthosis wearing protocol and regular follow-up. When recurrence develops, the choice of treatment method should be individualized considering the patient's age, severity of deformity and previous treatment. Further research is needed to standardize recurrence diagnostic criteria and develop innovative treatment methods.