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Although the level of symptoms is very variable and ankle and hindfoot arthrodeses have the disadvantage of increasing mechanical stress and subsequent arthritis in the midfoot, arthrodesis and, to a lesser degree, osteotomy remain the mainstays of surgical reconstruction in the adult with painful deformity after. Relapses, subsequent treatment. Wallace Lehman, MD, of New York University's Hospital for Joint Disease in New York noted that the method is not a silver bullet for the condition. Patient noncompliance. Neglected clubfoot. Genetic causes of clubfoot. MRI studies. Ponseti is the 'gold standard' Select cases need surgery.