The Ponseti Method is a non-surgical method for correcting clubfoot, making use of stretching, manipulation and serial plaster casts to reposition the foot. Once correction is achieved a brace (worn at night only) is used to maintain it.
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briefly:
- It takes about 4 or 5 weeks to correct the cavus, varus and adductus components of the deformity.(The feet are first moved outwards)
- Then the equinus is corrected.(The feet are stretched upwards)
- If the angle of dorsiflexion (upwards movement of the foot) achieved is less than 10 degrees above the neutral position, then a tenotomy is done to lengthen the heel cord and achieve an extra 10-15 degrees dorsiflexion. (about 85-90% of patients need the tenotomy)
- The final cast is left on for 3 weeks once the foot has been fully corrected. The maximum dorsiflexion achieved and 70 degrees abduction are held by the final cast.
- The child wears a brace to help maintain correction for 23 hours/3 months and then for naps and night-time sleeps thereafter until the age of about 5 years old.
more details: |
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The Ponseti Method is best started in the first week or two after birth when tissue and tendons are more pliable, but it is still an effective treatment for older children too.
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Once a week, after first stretching the tight tendons and ligaments etc., the feet are gently manipulated into the required position. Then a plaster cast is applied to hold the new position.
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Feet are first moved outwards about 10-15 degrees each week until they have been positioned at about 70 degrees abduction. Once the feet have reached maximum abduction, the doctor works on dorsiflexion (moving the foot up). The feet aren't just stretched to a neutral/flat-on-the-floor position, but up to 15-20 degrees above neutral. This is great because if muscles/ligaments/tendons stiffen a bit over the years the child will still have good movement and flexibility in the foot.
- Casts are only left on for 5-7 days at a time, except for the last cast which is left on for about 3 weeks. (after the tenotomy).
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Casts must only be removed just before the next visit to the doctor, as the foot can start to relapse after just a few hours without a cast.
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Casts are full length
(from toes to thigh). This ensures that the feet are held in the
correct position. (NB: Note that short casts do not hold the feet in
abduction/outwards so are NEVER used)
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On average it seems that there are about 4-8 casts in total.
If more than 8 casts are used the practitioner may not be following the
Ponseti Method accurately. More casts are only used for really bad
cases of clubfoot, but even then, only about 12 sets.
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For the best results the doctor must have an assistant
to help with keeping the child’s foot and leg totally still and
properly positioned while the cast is being applied. The doctor should
not be casting and trying to position the foot at the same time. This
causes problems. A parent also needs to be keeping the baby calm, happy and distracted during the casting. (giving baby love, assurance, dummy, bottle, toys etc.)
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Babies are sometimes sedated if they
fuss during casting just to calm them and to ensure that the cast is
applied properly and comfortably.
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If the foot is fully corrected, but the
Achilles tendon is still too tight for the foot to lift up (dorsiflex)
less than 10 degrees above the neutral position, a tenotomy will be done. The skin is punctured and
the short Achilles Tendon is cut so that it can regenerate itself a bit
longer, so that the foot can lift upwards comfortably. (The incision is
so small it doesn’t even require a stitch). The foot is then recast for
about 3 weeks this time. The final cast holds the foot in position
while the Achilles Tendon heals and lengthens. (NB: Note that the
tenotomy is only required to lift the foot up beyond a
level/’flat-on-the-floor’ position. The foot should already be looking
normal apart from the fact that it points downwards. The practitioner
must not do the tenotomy thinking it will help with correcting anything
other than the equinus. If the foot is still pointing inwards or the
heel still rocks in so that the foot rests on its outer edge, the
tenotomy will not work.)
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To avoid relapsing after the casting
phase, babies wear a Foot Abduction Brace (FAB) for 23 hours a day for 3
months. This brace holds the foot in an abducted (facing outwards)
position and lifted upwards (dorsiflexed). This keeps the tendons
stretched and flexible.
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The brace needs to be available for use
as soon as the last cast is taken off as it is not advisable to leave
the newly corrected feet without anything to help retain the new
position. (otherwise regression can take place).
Disclaimer: This is not a medical site.
All content is from a mother's perspective and understanding. I believe all content to be accurate, but am not a medical doctor. This information was written in 2011.
