Ponseti Method for Clubfoot

Gillette Children’s Specialty Healthcare is one of the nation's Best Children's Hospitals in pediatric orthopedics. Our pediatric orthopedics team uses the Ponseti method as a first treatment for clubfoot, because it can deliver excellent correction without surgery. Even if surgery for clubfoot becomes necessary, the Ponseti method is an effective way to begin improving the position and appearance of the foot.

Why Choose Gillette?

  • Gillette is one of the nation's Best Children's Hospitals in pediatric orthopedics.
  • Our skilled providers are experts in diagnosing and managing clubfoot; we treat more than 1,000 children with the condition each year.
  • We specialize in using the Ponseti method before considering surgery.
  • Our specialists collaborate to provide care for children who have conditions related to clubfoot, such as developmental dysplasia of the hip (DDH), cerebral palsy, spina bifida and other complex issues.
  • We believe that clinical research and an emphasis on outcomes promotes the highest standards of care.

Ponseti Method Definition

The Ponseti method—widely used by pediatric orthopedic providers to treat clubfoot—improves both the appearance and function of the foot. Ignacio Ponseti, M.D., an orthopedic surgeon, developed the method in the 1940s. It involves weekly foot manipulations and multiple plaster-cast applications, followed by diligent bracing.


Candidates for the Ponseti Method

Infants and children who have clubfoot can benefit from the Ponseti method. Candidates for the intervention might also include patients who have conditions associated with clubfoot, such as:

The younger the patient is when treatment begins, the better the results typically are. Ideally, patients should begin treatment within the first weeks of life; that increases the possibility that conservative or nonsurgical treatments will resolve clubfoot. Treatment outcomes vary depending on the presence of associated conditions and the initial severity of the clubfoot.


What to Expect

The Ponseti method gradually corrects clubfoot through a series of foot manipulations and plaster-cast applications. Babies tolerate the treatment very well, with minimal discomfort. The duration of treatment is typically less than three months, even when patients also need an outpatient procedure to lengthen the Achilles tendon. A four- to five-year maintenance phase follows treatment to prevent recurrence.

Manipulation and Casting

In the Ponseti method, a specialist gently exercises and stretches the foot before applying a cast. The cast extends from the foot to the top of the thigh. The long cast helps control leg movement and hold the foot in the proper position. Casts are changed weekly for approximately six or seven weeks. Each cast straightens the foot a little more. During treatment, families should play with, carry and move their babies as they normally would without the casts.

Achilles Tenotomy

Following casting, most children still have an abnormally tight Achilles tendon. A pediatric orthopedic surgeon can correct this problem with a quick outpatient surgical procedure to lengthen the tendon. The procedure typically occurs through a small puncture under local anesthesia. After the surgeon lengthens the tendon, patients wear a final cast for approximately three weeks.

Maintenance

After removal of the final cast, patients wear sandals that hold the foot in the proper position. A metal bar attached to the bottom of each sandal keeps the foot turned out. Infants wear the sandals 23 hours a day for three months, then wear them whenever they sleep until they are about 4 or 5. All children who have clubfoot, regardless of treatment, will need this maintenance phase—which can involve splinting or bracing—to help prevent recurrence.  

Treatment of Recurrence

In some children, clubfoot recurs. That situation requires repeat casting and lengthening of the Achilles tendon. Some children might need additional surgery when they are 2 to 4 years old.  The initial condition of the foot, and the presence of other underlying conditions, can affect whether clubfoot recurs. It’s important that a pediatric orthopedist monitor each child’s progress and address issues as soon as they’re noticeable.


Ponseti Method Outcomes

The long-term goal of the Ponseti method—and related clubfoot therapies—is to correct clubfoot and maintain the correction. We strive for the best possible alignment and range of motion of the foot to support growth and development.

In the vast majority of cases, providers can successfully correct clubfoot using the Ponseti method. Studies show that patients treated with the Ponseti method have a more flexible foot and ankle than do those treated with only surgery. Long-term studies of the Ponseti method demonstrate that its benefits that extend into adulthood.

The doctor who developed the method, Ignacio Ponseti, M.D., says, “The well-treated clubfoot is no [disability] and is fully compatible with a normal active life.”


Our Ponseti Method Services

Proper treatment of clubfoot and related conditions requires a team approach. Gillette’s experts specialize in the Ponseti method and in many other services that patients who have clubfoot need.

Specialties most often associated with treatment of clubfoot include:

Depending on a patient’s needs and associated conditions, providers who specialize in rehabilitation therapies and other specialties might be part of the care team. We also welcome the involvement of primary care providers, teachers, and school and community therapists. Working together, we help patients achieve their best possible outcomes.

For information about the comprehensive services we provide at Gillette, search Conditions and Care.

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