The Evolution of the Treatment of Clubfoot from Posterior Medial Release to the Ponseti Technique: My 42-Year Journey at the Permanente Medical Group

Abstract

Traditionally, the Kite manipulation and casting were utilized for the treatment of the congenital clubfoot. This was followed by an extensive posterior medial soft tissue surgical release followed by more casting. Often, the results were less than optimal with scarred, painful feet that needed further corrective surgery. Dr. Ponseti developed a different technique of manipulation, casting, and an Achilles tenotomy that fully corrected these clubfeet without the need for the extensive surgery. This was followed by the mandatory use of night braces with special shoes for a period of 4 years. The Ponseti method is now universally utilized around the world and is the standard of care for the management of clubfoot. I was fortunate to have been personally trained by Dr. Ponseti, and I have exclusively practiced this technique for the past 25 years.

Keywords: Clubfoot casting; Clubfoot surgery; Pediatric deformity; Ponseti.