Clubfoot - Ponseti Management

Dr. Ignacio Ponseti

The Ponseti Management is the best method for all countries and cultures because the feet are strong, flexible, and pain-free for a lifetime. In addition, the treatment is inexpensive and non-invasive.

Principles of Correction

In the overwhelming majority of infants, the clubfoot can be corrected over a period of several weeks through manipulation and the application of casts. This correction is made in several steps.

Cavus Correction

Note: The untreated cavus deformity of the foot [A]. Correction is achieved by supination of the forefoot [white arrows in B and C].

Adductus & Varus Correction

Note: The correction of adductus [A] and varus of the big toe [B] occurs when the foot is everted and abducted around the head of the talus.

Cast Application

Note that a circular plaster cast is applied in stages to maintain the correction achieved from manipulation [A - I]. The view of the cast and foot shows the correction [J].

Cast Removal

Remove the cast after remanipulation. After immersing the cast in water, use a knife to avoid frightening the child.

Tendon Lengthening

Almost all infants will require a percutaneous lengthening of the Achilles tendon. Perform this in the clinic with local anesthesia [A-E]. Cast in dorsiflexion [F]. Note the final correction [G].

Brace

After correction, a brace is essential to prevent recurrence. Effective brace types include: Denis Browne [A], Steenbeek [B], Lyon [C], and Gottenberg [D] designs.