The Ponseti Method

A non-surgical treatment for clubfoot

Clubfoot requires a proper medical evaluation and will not resolve on its own. Ideally, non-surgical treatment (Ponseti method) is started as soon as possible after birth. The treatment involves weekly stretching of the foot in the clinic, followed by the application of long leg plaster casts. The cast is removed and reapplied every one to two weeks and this process continues for approximately four to six weeks. A newborn with a congenital clubfoot should expect the deformity corrected in about five to six weeks. 

Before application of the final cast, the physician usually performs a tenotomy which is a non-invasive surgical procedure to lengthen the Achilles tendon. The incision is so small that no stitching is required. The child wear a final cast for three weeks to allow the tendon to heal. 

Three weeks after the final cast is removed, the child is fitted into a brace (foot abduction orthosis) designed to prevent the clubfoot deformity from recurring. This brace will be worn continuously for the first three months, followed by night and naptime wear for up to four years.

Benefits of the Ponseti method

The Ponseti method delivers excellent correction of clubfoot without the associated risks and complications of major foot surgery. Moreover, studies show that patients treated with the Ponseti method enjoy a more flexible foot and ankle than those treated surgically. Long-term studies of the Ponseti method have demonstrated that cast correction of clubfoot not only helps dramatically during childhood, but also in adulthood.

The Ponseti method requires specific training. St. Louis Children's Hospital has one of few clinics in the nation that offers this non-surgical treatment by a certified physician. The clinical team has also developed enhancements to increase brace-wearing compliance and patient comfort. First, the clinic teaches parents the science of stretching and exercising their child's feet to improve the ankle's mobility. Second, the clinic uses a foot abduction orthoses system or a custom Ankle Foot Orthosis on a dynamic bar depending on each child’s condition and brace tolerance.  It also allows independent leg movements. This brace has a higher rate of patient compliance than the traditional clubfoot orthosis. 

To contact the clubfoot treatment team at St. Louis Children's Hospital and to request an appointment, call 314.454.5437 or 800.678.5437.