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Ponseti Technique 

Brett Cascio, M.D.

Ponseti Technique 

Ponseti Technique

What is the Ponseti Technique?

The Ponseti technique is a method of treatment of congenital clubfoot that was first described by Professor Ignacio Ponseti. It is a technique that involves manipulation and repositioning of the foot that is conducted over a period of time. The goal of treatment is to correct foot deformity gradually and ensure that the foot remains in the required position following treatment.

Phases of Ponseti technique

1 - Treatment phase

This involves gentle manipulation and plaster cast application conducted over a period of weeks and months. While correcting the deformity, the foot is manipulated into a position and then the cast is applied to maintain that position for a week or so. The ideal plaster cast is one that extends all the way from the groin to the foot.

Different aspects of the foot are treated initially which helps restore the tone of the Achilles tendon and corrects the inward rotation of the foot. The cast is applied along the entire length of the leg and this enables adequate tendon and ligament stretching. Shorter casts are not effective. With every passing week, the casts are removed and the foot is repositioning and yet another plaster cast is applied. With this method of serial casting, the tendons eventually relax, the bones realign and the foot regain is its normal position.

A total of 5 to 6 casts are required to help correct clubfoot using the Ponseti technique. The overall duration of treatment is anywhere between 6 to 8 weeks. Once the foot is manipulated into position, a final cast is applied that is left on for up to 3 weeks. Prior to application of this cast the tendon that connects the calf muscles to the heel bone is cut under local anesthetic. This helps to relax the muscles and reduce the stress that is placed on the heel bones.

2 - Maintenance phase

This involves applying orthoses to the feet of the child to help keep the foot in position. A brace is worn that keeps the foot in the position required for up to 23 hours a day. Braces may be required for up to 3 months and following that the duration may be reduced to only night-time application till the child is four years or so. Following this regime helps prevent recurrence of clubfoot. The maintenance phase is essential as studies have shown that not wearing braces following Ponseti technique can result in most cases recurring.

After Surgery

The main advantage of the Ponseti technique is that it is safe and effective when followed as described. It avoids the requirement for surgical manipulation and long-term results are very good. It is now the treatment of choice for infants suffering from clubfoot.

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