Ponseti Method of Treating Clubfoot

Dr. Ignacio Ponseti developed a method of correcting clubfeet in infants without the use of surgery. The treatment uses manipulation developed by Dr. Ponseti using plaster casts to correct the deformity. The manipulation through casting is based on foot anatomy and the response of muscles and ligaments. Bone changes are also manipulated by casting. Bracing is used to keep the feet growing in the right direction once casting has been completed.

Casting

• Treatment for clubfeet should begin within the first two weeks of the baby's life. Ponseti-style casting goes from the toe to the groin and is made of plaster. Weekly visits to the doctor should be made to have the ligaments and tendons stretched in a gentle manner and to have a new cast applied. Continue this schedule for five to eight weeks. During this process, the bones are gradually brought into correct alignment. The last plaster cast is to be worn for three weeks.

Bracing

• Once complete rectification has been achieved, bracing is needed to prevent a relapse. Have the brace applied the same day the cast is removed. If the bracing or splint is not ready that day then a holding cast should be implemented. The brace must be worn at all times for the first two to three months. As the child grows, adjust the bar for comfort.

  During the first three months of wearing the splint, have the child wear the brace 23 hours per day. Slowly begin to wean the child from using the brace. For the next month, have the child wear the brace for 20 to 22 hours. Decrease the hours to 18 to 20 hours per day and then 16 to 18 and then 14 to 16 hours per day for each following month. Allow the child to have rest periods, as it is not necessary to wear the brace in consecutive hours. It is best to have the child wear the brace during the night and during nap times. Once the child is walking completely on his own, reduce the time the brace is worn to 12 to 14 nightly hours until he is 4 or 5 years old.

Using the Brace

• Use cotton socks while the child is wearing the brace. Place the child's foot into the shoe, and while bending the child's knee, gently push on the foot to make sure the heel is solidly in the shoe. Tighten the strap. Pull up and down on the lower half of the child's leg. If the child's toes are moving back and forth, the heel is not seated properly. New shoes are needed when the baby's toes are curling over the edge. Purchase shoes that are larger by two sizes. Use a permanent marker and put a mark where the joints are on the bar before make the change. The baby's shoulders should be able to fit in between the distance between the shoes.