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What Is the Ponseti Method?

By Amanda Barnhart
Updated May 17, 2024
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The Ponseti method is a form of treatment for infants born with clubfoot. Traditional treatment for the deformity involves surgery to move the bones, tendons, and ligaments in the foot to straighten it. The Ponseti method of treatment does not require surgery and can successfully straighten most infants' feet through a casting process and maintenance period designed to manipulate and stretch the joints and ligaments in the feet.

Dr. Ignacio Ponseti developed the manipulation method for clubfooted infants at the University of Iowa in the 1940s, though it was not until the 1990s that the procedure started to become more common in other parts of the United States and throughout the world, including Third World countries. The first part of the procedure involves a series of casts applied to the infant's feet. A doctor gently stretches the foot and ankle and applies a cast to hold the foot in the desired position. A new cast is applied about once a week for the first few months of life to stretch the foot a bit further each time.

After the casting process is complete, the child wears custom-made shoes with a metal bar in between them at all times for another six months. This device prevents the child's feet from turning inward and helps stretch and manipulate the tendons, bones, and soft tissues in the feet further. Around the child's first birthday, parents can begin allowing their child to wear normal footwear during the day, but the metal bar must still be worn at night until the child is three or four years old to complete the manipulation process.

Treatment with the Ponseti method is often more desirable than traditional surgery due to several factors. Surgery to correct clubfoot deformities can be very expensive, and in some countries qualified and trained surgeons are difficult to find. Infants who undergo surgery risk infection, anesthesia reactions, and problems with wound healing that do not occur when they are treated with the Ponseti method. One of the most compelling reasons for doctors and parents to choose manipulation techniques over surgery is that children treated with this method are typically more flexible and functional than children who undergo surgical treatment, which can lead to stiffness.

In most cases, children who undergo the Ponseti method of treatment for clubfoot have no further problems or disabilities later in life. Strict adherence to the program, particularly the maintenance period, is vital to ensuring that the child's feet are stretched appropriately. Many of the children treated with the Ponseti method require surgery to help stretch or move the Achilles tendon, but these surgeries are much more minor than traditional clubfoot surgeries.

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