The Ponseti Method
After centuries of treating clubfoot with casting and bracing, surgery became a popular option in the 1950-70’s but has since been found to lead to considerable health issues later in life. The feet tend to become stiff, weak and painful, often resulting in the need for additional surgeries.
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. When the non-surgical Ponseti Method (endorsed by the American Academy of Pediatrics and the National Institutes of Health) became the orthopedic standard for treating clubfoot in 2005, a global movement was born.
The method is extremely effective, restoring 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.
This medical innovation makes it possible to treat a leading birth defect and disability inexpensively and effectively on a global scale.
Ideally, treatment should begin within a week after birth, since the tendons and ligaments are at their most elastic and correction occurs most easily at this point. However, the Ponseti Method has been used very successfully on children up to the age of 6 and recently there is evidence that children as old as 16 can be treated effectively.
A note for parents: If you have a child with clubfoot, please be reassured that your child is very likely to be successfully treated using the Ponseti Method. Minimal or no surgery should be necessary, except in the most complicated cases (less than 5%). We recommend speaking with a Ponseti-trained doctor as soon as possible to create a treatment plan specific to your child.
The Ponseti Method is based on a deep understanding of the anatomy of the foot. Treatment using Dr. Ponseti’s approach 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 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.