Ponseti

Ponseti is a non-surgical treatment method for congenital clubfoot (talipes equinovarus) developed by Dr. Ignacio Ponseti. It uses gentle, systematic manipulation of the foot followed by weekly plaster casts to gradually correct the deformity. The process aims to realign the hindfoot, midfoot, and forefoot, with particular attention to correcting equinus.

In most cases, a percutaneous Achilles tenotomy is performed to release the tightness of the Achilles tendon and achieve full ankle dorsiflexion. After the correction is achieved, a period of casting continues for a few weeks to maintain the new position. Following casting, the child is fitted with a foot abduction brace (often a Denis-Browne or similar device) to keep the feet in abduction and to prevent relapse. The brace is typically worn full time for several months and then at night for several years, depending on age and protocol.

The method has become the preferred initial treatment for most clubfeet worldwide due to its high success rates, minimized need for extensive foot surgery, and favorable functional outcomes. Success is closely linked to early treatment, accurate technique, and strict adherence to the bracing schedule. Inadequate bracing or poor follow-up can lead to relapse, sometimes requiring further intervention.

The Ponseti method has also been adapted for neglected clubfoot and older children, though older deformities may require more casts and sometimes additional procedures. Training programs and international guidelines promote standardized training to ensure consistent results across diverse settings.