[Ponseti method for treatment of idiopathic clubfoot]

Abstract

Objective: Pain-free, plantigrade, functional foot through gentle manipulation without extended surgery and with decreased probability of relapse.

Indications: Idiopathic clubfoot; neurogenic and secondary clubfeet.

Contraindications: None.

Surgical technique: Simultaneous correction of all components of the clubfoot. Mainly conservative, with serial casts. Slight supination to address the cavus and increasing abduction to align the midfoot bones while putting counter-pressure on the head of the talus. Surgery primarily only to correct the equinus, which can often not be accomplished through casting, and consists of a simple subcutaneous section. Due to tendency to relapse, further surgery might be necessary, followed by serial casting. Remaining deformity can be treated by percutaneous lengthening of the Achilles tendon, percutaneous release of the plantar fascia or a transfer of the tibialis anterior tendon to the third cuneiform.

Postoperative management: Abduction orthosis for stabilization of the clinical result 24 h/day for 3 months, then only at night- and naptime through end of the third year of life. Follow-up every 3-4 months.

Keywords: Achilles tendon; Foot deformities, congenital; Infant, newborn; Relapse; Surgical cast.