Ponseti Method

Ponseti Method consists of 3 phases:

Correction

Maintenance

Surveillance

Ideally treatment begins during a child’s first few weeks of life to take advantage of the elasticity and suppleness of the tissues at that age.

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Correction

Part A: Casting

Your child’s foot will be gently manipulated during weekly visits to stretch the ankle and foot ligaments and tendons. These are short and tight at birth with clubfoot. A cast is applied to hold the foot in a progressively corrected position each week. The tissues relax while being held in a cast to allow for the next stretched position. Eventually, the displaced bones and joints are correctly aligned. Each week your child’s foot will show change in shape during the process. The casts should always cover your child’s toes to groin, but may be made of plaster or fibreglass. At the end of the casting process, all parts of the clubfoot are corrected except for the equinus (the downward pointing).

Part B: Tenotomy

Prior to the last cast, an Achilles Tenotomy is performed to release the Achilles tendon which is thick, stiff, and resistant to stretching. The tenotomy corrects the equinus and provides good ankle motion for your child.

The tenotomy is considered a short, minor procedure and is safe for your child. Often it is done in the outpatient clinic under local anaesthetic of the area. The procedure creates a gap in the tendon, which heals quickly in a cast, resulting in a longer tendon with increased flexibility. No stitches are needed as the skin incision is very small. The ankle and foot are then casted for three weeks in the fully corrected position as the tendon heals.

MAINTENANCE

Despite correction during casting, clubfoot is considered stubborn as it has the tendency to relapse or come back. Maintenance is a critical piece in your child’s journey to prevent relapse.

Your child will be prescribed a foot abduction brace (FAB) to hold the foot or feet in the corrected position. These braces are commonly referred to as boots and bar or BNB by parents.  The brace “abducts” or rotates the feet outward. It consists of two speciality shoes and a bar, which holds the feet in the corrected position. At first, the brace is worn 23 hours a day for 2 to 3 months. A short time is given each day for bathing and brace free cuddles and play. Wearing the brace will not significantly delay your child’s gross motor development, and they will find ways to roll, sit, and even crawl in the brace if ready. However, not wearing the brace as prescribed will dramatically compromise the correction made during casting.

Once approved by your doctor, bracing will be reduced to nights and naps (or specific hour duration) until your child is four years old. Occasionally, your doctor may encourage a longer duration of brace wearing (up to six years of age) depending on your child’s tendency to relapse and clubfoot severity. When not wearing the brace, most children are able to wear normal shoes during the day. The foot abduction brace is the only brace that prevents relapse. When used as prescribed, the brace is over 90% effective. The foot braces need to fit correctly, like shoes, and your child will require new ones as their foot grows with age.

Doctors may recommend physiotherapy during maintenance to help prevent relapse with stretches and strengthening exercises. A physiotherapist that specializes in children can provide age-appropriate routines that are fun and effective for your child.

SURVEILLANCE

It is important to continue to have your child’s foot or feet checked regularly after brace wearing is complete, to watch for relapse or detect any changes during growth. For example, unilateral clubfoot may result in slight differences in leg length and foot size.

Check-ups decrease after the bones stop growing, roughly age fourteen for females and sixteen for males. Your doctor will advise you on scheduling follow ups. Occasionally, surgery is needed after the maintenance period. A difference in leg-length may cause pain and need to be addressed, or repeated relapses may require a tendon transfer.

Source: “A Parents’ Guide to Clubfoot” – Canadian Orthopedic Foundation