Early signs of relapse may manifest as the child developing intolerance to the boots and bars. In walking-age children, visual cues include the foot curving inward, with the heel pointing inwards when viewed from behind. Addressing relapses involves repeat Ponseti serial casting to stretch the deformity. In older children with initial successful treatment, a relapsed clubfoot may indicate muscle imbalance, causing the foot to deviate back toward the original deformity. This becomes apparent when the child points their foot up, and instead of pointing outwards, it points inwards. This is particularly observable during walking as dynamic supination of the forefoot during the swing phase of gait.