The Ponseti Method

Most orthopaedic surgeons agree that the primary treatment for clubfoot in young children should be conservative. The treatment technique with the most scientific evidence supporting its effectiveness is the Ponseti method (5). Compared to surgical and other conservative techniques, the Ponseti method has been found to have the best long term outcomes (7), and and is considered the gold standard of treatment for clubfoot by Global Clubfoot Initiative.

The goal of clubfoot management is to provide long term correction of the deformity resulting in a foot that is fully functional, pain-free (7) and without callouses and able to wear normal shoes (26).

The Ponseti technique is completed in several stages which fit into two phases, both of which are essential to achieving correction of deformity.

Phase 1: Achieve correction of deformity (manipulation, casting, tenotomy).
Phase 2: Maintain correction (using Foot Abduction Braces)

The stages of Ponseti treatment are:

    1. Manipulation and Casting: Gentle, weekly manipulation and stretching of the foot in order to correct the deformity. Each time the foot is manipulated it is put into a long-leg plaster cast with the knee bent to 90 degrees in order to hold the corrected position, usually for one week. After a series of several manipulations and castings the deformity can usually be almost fully corrected apart from the equinus position of the midfoot and ankle.
    1. Achilles Tenotomy: The equinus position of the foot, caused by the tight and shortened Achilles tendon in almost all cases requires a small surgery in order to be corrected.  This procedure is a complete tenotomy of the Achilles tendon which can be carried out under local anaesthesia.
    1. Final Casting: Immediately after the tenotomy a final cast is applied in an over-corrected position for a further three weeks.
    1. Bracing: Bracing using a Steenbeek Foot Abduction Brace (SFAB) is started as soon as the final cast is removed. Braces must be worn 23 hours/day for three months following treatment and then 11 hours/day (while the child is sleeping at night) until the child is four years old. Bracing is essential in order to maintain the corrected position of the foot and prevent relapse of deformity because the genes that cause clubfoot may be active until a child is four years of age. The SFAB is a cost-effective brace, which is produced all over the world using locally available materials.

The Ponseti method must be started whilst the child is still young – ideally between a few days to several months old. Generally, the earlier treatment is started the easier a clubfoot is to correct. However, the Ponseti method is now being used with older children, in some cases up to the age of ten years old (22). In older children the decision about whether the Ponseti method is the most appropriate technique to use largely depends on the flexibility of the child’s foot, the skill of the clinician and the resources available.

The Ponseti method is a very specific technique; in order to gain the desired results it is extremely important that it is performed accurately. GCI recommends that the instructions in the Global HELP Ponseti manual are followed closely. The resources collection contains training materials for, and more information about, the Ponseti technique.

The information provided by GCI is based on publications in scientific journals (references indicated by numbers within the text). To see the full reference list click here.