Treatment

Current preferred treatment for clubfoot is the Ponseti method (1) - is a detailed method of manipulation and casting without major surgical releases

• treatment preferences is via a primarily a non-operative approach through the Ponseti method
  • method has become the standard of care and completely eliminates the need for extensive operative correction in over 98% of patients if applied correctly
  • treatment involves manipulation, a series of castings, percutaneous Achilles tenotomy and foot bracing (2)
  • a precise sequence of manipulations of the clubfoot that lead to correction of the deformity
    • Ponseti stressed that the cavus should be corrected by raising the first metatarsal, which initially makes the deformity look 'worse,' and that correction should occur around the head of the talus without the heel being touched. At weekly intervals the foot is manipulated into the maximum position of correction and then held in a plaster of Paris cast.
  • with correct application of the procedure and appropriate patient adherence, complete correction can be achieved in as little as 16 days with an accelerated casting protocol

Reference:

• Bridgens J, Kiely N. Current management of clubfoot (congenital talipes equinovarus). BMJ. 2010 Feb 2;340:355.
• Desai L et al. Bracing in the treatment of children with clubfoot: past, present, and future. Iowa Orthop J. 2010;30:15-23.