In the treatment of congenital clubfoot with Ponseti method, majority of secondary procedures which is used for relapses or residual deformities are composed of Achilles tendon release and tibialis anterior tendon transfer.
Equinus deformity caused by contracture or shortness of gastrocsoleus muscle-tendon complex is the most troublesome pathology of the early treatment period or subsequent follow-up that developes frequent complications and necessitates further treatment. The second most common problem encountered after the primary casting is the dynamic forefoot supination deformity. Equinus and forefoot supination may be isolated or co-existant. In both cases, delaying the treatment of these deformities leads to additional structural changes and then turns to a complex foot deformity which is more difficult to correct. Treatment of congenital clubfoot almost always starts with Ponseti casting, and recasting is the primary choice of treatment when deformity relapses. Nevertheless, if these deformities do not improve with casting, surgery should not be delayed.