The Ponseti Method for Clubfoot Correction

The Ponseti technique is rapidly becoming the most widely practiced method for initial treatment of congenital clubfeet in infants. It is an easy technique to learn and, when applied accurately, yields excellent results. It consists of gentle manipulation and casting of the feet at weekly intervals. The first cast is applied with the foot supinated and attention directed to elevating the first ray. Subsequent casts are applied to abduct the foot around the head of the talus, taking care never to directly manipulate the calcaneus. At the time of the final cast, the overwhelming majority of infants require a percutaneous Achilles tenotomy to allow sufficient dorsiflexion. The final cast remains in place for three weeks, at which time the infant is placed into a foot abduction orthosis. The orthosis is worn 23 h per day for 3 months and then at night for several years. Good results have been demonstrated at multiple centers and long-term results indicate that foot function is comparable with that of normal feet.