This medical innovation makes it possible to treat a leading birth defect and disability inexpensively and effectively on a global scale.
Until the past decade, most children born with clubfoot in low- and middle-income countries were not treated due to the complexity of surgery and limited access to safe services. (Surgery became the popular option in the 1950-70’s but caused considerable health issues later in life; the feet tend to become stiff, weak and painful, often resulting in the need for additional surgeries.)
When the non-surgical Ponseti method became the orthopedic standard for treating clubfoot around 2005, a global movement was born. This method provides full mobility in 95% of cases.
It requires a series of casts to gently manipulate the feet, a simple outpatient procedure to release the Achilles tendon, and afterwards, a brace worn while sleeping at night to prevent relapse (following an initial three-month period when it is used for 23 hours/day). The simplicity of this non-invasive treatment is ideal for low-resource settings.
The Ponseti Method
A series of casts stretch the feet, followed by a simple procedure to release the Achilles tendon.
The Ponseti method is endorsed by the World Health Organization, the American Academy of Pediatrics, the American Academy of Orthopedic Surgeons,the Pediatric Orthopedic Society of North America, the European Pediatric Orthopedic Society, as well as more than 35 national and regional orthopedic societies globally.
Developed by Dr. Ignacio Ponseti in the 1940s-50s, the method results in complete correction and full functionality in 95% of cases. When treatment is initiated during infancy, correction is usually achieved within six to eight weeks.
Ideally, treatment should begin within a week after birth, when the tendons and ligaments are at their most elastic. However, the Ponseti Method has been used successfully on children up to the age of 6, and growing evidence shows that children as old as 16 can be treated effectively without major surgery. Since 2018, MiracleFeet medical partners in 20 countries have treated more than 600 patients between the ages of 10-17—among more than 63,000 children treated since 2010.
The Treatment Process
Treatment using the Ponseti method will in most cases involve 5-8 weeks of manipulations and castings. The foot is precisely and gently manipulated and then placed in a long leg (toe to groin) plaster cast. The cast should be well molded around the foot.
The cast is removed after 5-7 days and the process is repeated. The foot should be in a fully corrected position after 5-6 casts.
Most children will then require a tenotomy: a simple procedure to release the tightness in the heel usually done using local anesthesia. Three weeks later the last cast is taken off.
The child will wear a foot abduction brace–a simple bar and shoes device–that keeps the feet in a set position to prevent relapse. The brace is worn for 23 hours a day for the first 3 months and then at night and during naps for 4-5 years. The brace prevents the corrected feet from relapsing. Bracing is the only statistically significant factor in relapse, so this phase of treatment is extremely important. Although many parents worry about their child tolerating the brace, most people find the children get used to it quickly and learn to kick, crawl, stand up and even walk in the brace.