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PONSETI Method

Nowadays, surgical interventions for clubfoot in infants can be avoided in approx. 90% of the cases by using the Ponseti method of conservative clubfoot treatment.  This treatment method is becoming increasingly popular in Europe due to the great success it has brought in congenital clubfoot therapy.

The Ponseti method is initially based on weekly corrections using plaster casts.  Thanks to this gentle process of casting – i.e. the gradual correction of the abnormal foot-position by stretching and then plaster-casting – the Ponseti method allows complex operations to be avoided.

With operations, children run the risk of scarring, stiff joints, and muscular debility.  By contrast, the focus of the Ponseti therapy is on the functional capability of the foot: several scientific studies have documented the success of this gentle and equally effective therapy concept.

Optimally, the treatment of clubfoot should be started within the first two weeks after birth in order to take advantage of the initially high elasticity of ligaments and joint capsules which facilitates the therapy.  A cast is applied after each treatment session in order to maintain the corrected position.  During the process, the individual foot-bones are gradually brought into their proper positions.  Normally five or six casts are sufficient to correct the clubfoot deformity.

In the process, the foot is rotated outwards in stages; a slight rotation every week over a period of 4-5 weeks.  It is subsequently “locked” into position with a cast which is applied from the toes up to the thigh.  Thus, high-arch foot and the sickle-position are corrected in the first phase and the rearfoot is positioned.  The clubfoot is corrected right at the end.  A percutaneous tenotomy of the Achilles tendon is necessary in about 80% of the cases in order to correct the remaining clubfoot.  This surgery involves the separation of the Achilles tendon with a prick incision.  It is a risk-free intervention which is followed by the rapid regeneration of the tendon.  After the operation, a final cast is applied under maximum dorsiflexion and abduction (i.e. accentuation of the instep and the outer spread angle) for about 3 weeks.  In the subsequent therapy phase, carbon-fibre braces are used to prevent a relapse back to the previous abnormal position.