Treatment of Clubfoot Using the Ponseti Method

JBJS Essential Surgical Techniques
Frederick R Dietz, Kenneth Noonan

Abstract

The Ponseti method consists of a specific technique of manipulation of the clubfoot deformity, followed by the application of a plaster cast with the foot in the corrected position. A percutaneous tenotomy of the Achilles tendon is done prior to the final cast to gain complete correction in most patients. Bracing with a foot abduction orthosis is necessary to minimize relapse of the deformity. The method begins with the Ponseti manipulation and consists of the following steps: (1) Identify the head of the talus by palpation. (2) Supinate the forefoot to eliminate the cavus deformity and create a normal-appearing arch. (3) Abduct the forefoot with the vector of force parallel to the sole of the foot while using the lateral head of the talus as the fulcrum and maintaining the reduction of the cavus deformity. (4) This manipulation is followed by the application of an above-the-knee cast with the foot in the corrected position. (5) The manipulation and casting steps are repeated every 5 to 7 days until the foot is abducted approximately 50° from the frontal plane of the tibia. (6) In most patients (60% to >90%), a percutaneous tenotomy of the Achilles tendon is necessary to correct the residual ankle equinus after gaining full abd...Continue Reading

References

Oct 1, 1995·The Journal of Bone and Joint Surgery. American Volume·D M Cooper, F R Dietz
May 3, 2006·The Journal of Bone and Joint Surgery. American Volume·Matthew B DobbsPerry L Schoenecker
Jun 22, 2006·Clinical Orthopaedics and Related Research·Ignacio V PonsetiJose A Morcuende

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Citations

Feb 8, 2020·Journal of Pediatric Orthopedics·Chris ChurchLouise R Nichols

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