The Ponseti method is the gold standard for treatment of congenital clubfoot. With strict compliance, it results in highly functional and pain-free feet.

The Ponseti technique involves manipulation, casting and percutaneous Achilles tenotomy. It requires fewer casts, less time and has a better success rate than other methods. It also has a lower incidence of relapse.

Casting

The first step in treating clubfoot is to place a series of casts on the child’s feet. These casts will gradually move the clubfoot toward the normal position of the foot. It’s best to begin treatment with the Ponseti Method within a week or two of birth, when the tendons and ligaments are most elastic. A trained doctor will gently manipulate the foot, and then put it into a long leg (toe-to-groin) plaster cast. The cast will be replaced every five to seven days. After about five to six casts, the foot will be in a fully corrected position. Many children will need a tenotomy – a simple procedure to loosen the tight heel tendon – before the final cast is applied.

The Ponseti technique addresses all the elements of clubfoot: talipes varus, adduction, and hindfoot valgus in a way that respects the natural kinematics of the foot. This is essential to achieve adequate correction and minimize residual deformity. Several key pearls to optimize the casting process include efforts to minimize infant distress, appropriate cast and padding material, and the aggregate and interval timeline of casting.

Most babies need an average of 5-8 Ponseti casts to get their foot into the final corrected position. A tenotomy – a small procedure to loosen the tight heel tendon before the last cast is applied – is often required for most infants to gain complete correction.

Bracing

After your child’s clubfoot is corrected in a series of casts, the bracing phase begins. This is a crucial part of the Ponseti method that keeps the foot growing in the correct position. If the brace isn’t worn as directed, a clubfoot may return to its original, uncorrected position (this is called relapse).

While there are several different kinds of clubsfoot braces, most are designed to hold the foot in neutral or a little bit of abduction. They are also typically worn up to the thigh, which contributes to calf muscle atrophy.

The Ponseti method is successful for most kids, and permanent correction will let them walk, run, and play without pain. But it takes time and consistent use of the brace.

Many children will not initially tolerate wearing a clubfoot brace, especially for 23 hours a day. The best way to get your child to wear it is to make it a normal part of their daily routine, from the beginning. If you are unsure how to do this, talk to your doctor or the orthopedic specialist who treated your child for clubfoot.

Our partners in low- and middle-income countries told us that the most difficult aspect of scaling the Ponseti method was ensuring that kids would be able to easily use an affordable, easy-to-use clubfoot brace. MiracleFeet worked to develop a new design that is both functional and appealing, making the brace more comfortable and accessible for kids around the world.

Surgical Release

While the Ponseti method is a highly effective nonsurgical treatment, a small percentage of clubfoot patients do not respond to serial casting. In those cases, the comprehensive soft-tissue surgical release (known as the Cincinnati approach) can help. The procedure repositions the foot and ankle by loosening the tight ligaments. The foot is then casted to the final corrected position. This technique served as the orthopedic standard for many cases of idiopathic and syndromic clubfoot from 1970 to 1990.

Rarely for severe clubfoot and in cases that are part of a syndrome or other underlying medical condition, surgery is needed in infancy to more thoroughly correct the foot. This surgery involves releasing the posterior and lateral ligaments to allow more movement of the foot and ankle. Children who undergo this more extensive surgery will often need a brace to keep their foot in its new, more corrected position. Those children who have successful results with the Ponseti method and are not undergoing further treatment with surgery typically only need to see their specialist once a year to make sure they do not relapse into the clubfoot deformity.

Home Care

The non-surgical Ponseti method has been successful for many infants with clubfoot. This technique is a sequence of casting, a minimal surgical procedure to release the Achilles tendon, and bracing. Generally, a pediatric orthopedic surgeon who is experienced with this method will perform the casting. A child will wear the casts for about three months following each procedure. Then the child will wear a brace at night time only until he or she is 4 years old. The outlook for children who undergo the Ponseti treatment and maintain the brace is excellent.

The Ponseti method does not require X-rays, but most healthcare professionals will examine your baby’s feet at his or her first visit after birth to see if they are affected by clubfoot. The doctor may recommend an ultrasound to see the degree of the deformity.

The majority of cases (80%) of clubfoot are idiopathic, meaning they occur without a specific cause. However, the condition may be part of a syndrome or it can run in families. This type of clubfoot is called complex and it may be more difficult to treat. It is very important to begin treatment of clubfoot as early as possible, especially in infants. Those who start treatment sooner have fewer complications, less need for surgery and better long-term results. For the most severe cases, a minor surgical procedure may be required to fully correct the deformity.