Ponseti Method for clubfoot

NewsBot · Dec 20, 2024

Factors responsible for dropout in the Ponseti method of clubfoot treatment: A cross-sectional study
Manzoor et al
Qatar Med J. 2024 Nov 11;2024(4):63.

Background
The Ponseti method for clubfoot treatment is a non-surgical treatment with a successful outcome. However, many children are not able to complete Ponseti treatment due to various barriers and are termed dropout children. This study aimed to find out the factors responsible for dropout from clubfoot treatment in Peshawar, Pakistan.

Methods
The study was conducted in the Clubfoot Department of a tertiary care hospital. Clinical and demographic information like age, casting phase, bracing phase, and clubfoot types, i.e., idiopathic, syndromic, or neurogenic, were extracted from the hospital database, while for dropout factors, a semi-structured questionnaire was used. Descriptive statistics were applied to demographic data, assessments, and semi-structured questionnaires for parents. The association of dropout rates with age, gender, and unilaterally/bilaterally clubfoot was analyzed through chi-square tests.

Results
Between December 2017 and December 2022, a total of 1,150 babies were treated with the Ponseti method in the Clubfoot Department. Of 1,150 patients, 197 (17.1%) patients dropped out of the treatment. Twenty-four (12.1%) patients of this dropout were from the casting phase, and 173 (87.9%) patients were from the bracing phase. Age was found to be a significant factor affecting dropout from the Ponseti method. No significant association was found between the patient’s dropout and gender or between dropout and unilaterally/bilaterally clubfoot.

Conclusion
The Ponseti method improves clubfoot treatment but faces high dropout rates due to barriers like lack of family support and transport issues. Clinics addressed this by offering family support, transportation aid, telemedicine, community outreach, financial aid, peer support, and extended hours, reducing dropout rates and enhancing outcomes.
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NewsBot · Dec 26, 2024

Assessment of Gross Motor Skills in Ponseti-treated Children With Idiopathic Clubfoot at 3 Years Old: Insights from the Peabody Developmental Motor Scale 2
Rice, Samuel W. BS et al
Journal of Pediatric Orthopaedics 44(9)e846-e851, October 2024. | DOI: 10.1097/BPO.0000000000002771

Background:
Congenital talipes equinovarus, or clubfoot, can lead to lifelong functional impairments, including diminished gross motor skills (GMS), if left untreated. The Ponseti method corrects idiopathic clubfoot through casting and bracing. Given the importance of GMS in childhood development, this technique must be optimized to support childhood and long-term health outcomes. This study examined immediate posttreatment GMS in 3-year-old children treated with Ponseti, hypothesizing that they would perform on par with their nonclubfoot peers.

Methods:
Data from 45 children (33 to 46 mo of age) treated for idiopathic clubfoot were analyzed. The Peabody Developmental Motor Scales, 2nd edition, was used to assess GMS, and logistic regression identified factors influencing Gross Motor Quotient (GMQ) scores.

Results:
Approximately half (n=22) of the patients exhibited below-average GMS (11th to 25th percentile), with 11 scoring below the 10th percentile. Initial deformity severity, gender, and cast numbers did not impact GMQ. Repeat percutaneous tenotomy was associated with lower GMQs. Brace compliance significantly reduced odds of low GMQs by up to 80%. Age at testing and additional surgery were also linked to below-average and poor GMQs.

Conclusions:
GMS appeared to be impaired in almost half of the 3-year-old patients treated for idiopathic clubfoot, so our hypothesis was disproven. Repeat percutaneous tenotomy was associated with lower GMS, necessitating future recognition of patients who might be at risk of relapse. Brace noncompliance emerged as a significant risk factor, emphasizing early identification of these patients and education for their parents. This study offers a benchmark for clinicians and parents, but research on long-term outcomes is needed.
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NewsBot · Jan 10, 2025

Comparison between unilateral and bilateral clubfoot treated with Ponseti method at walking age: static and dynamic assessment
Marco Sapienza et al
J Pediatr Orthop B. 2024 Oct 1.

This study evaluated the static, postural, dynamic, and clinical outcomes among five groups of patients: a bilateral CTEV (congenital talipes equinovarus) group treated with tenotomy (n = 14), bilateral CTEV group treated conservatively (n = 6), unilateral CTEV group treated with tenotomy (n = 7), unilateral CTEV group treated conservatively (n = 3), and control group (n = 20). Data were collected through baropodometric examinations and clinical evaluations using Pirani, clubfoot assessment protocol, foot and ankle disability index (FADI), and American Orthopedic Foot and Ankle Society scores. Bilateral CTEV patients treated with tenotomy showed no statistically significant differences compared to healthy controls. Significant differences were found in lateral-lateral variation in the bilateral postural group (P = 0.002) and in static peak pressure in unilateral tenotomy patients (P = 0.046). Dynamic comparisons revealed significant differences in mean pressure between unilateral groups (P = 0.002) and lateral-lateral variation in bilateral groups (P = 0.004). The Pirani score showed significant differences between tenotomy-treated and postural patients (P = 0.000). Statistically significant differences in FADI scores were found between bilateral groups (P = 0.0037), between tenotomy-treated groups (P = 0.0020), and between the bilateral tenotomy-treated group and the unilateral postural group (P = 0.021). Bilateral CTEV patients treated with tenotomy develop static and dynamic values comparable to healthy controls. Bilateral patients develop better dynamic values compared to patients with a unilateral variant
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NewsBot · Jan 27, 2025

Determinants of Improvement in Foot Bimalleolar Angle, Pirani Score, and Recurrence in Clubfoot Patients Treated With the Ponseti Technique
Rajesh Kumar et al
Cureus. 2024 Dec 24;16(12):e76344.

Introduction: Foot bimalleolar angle (FBM angle) and Pirani score are recognized as assessment and prognostic tools for objective assessment of clubfoot (congenital talipes equinovarus, or CTEV) treatment. The present study proposed to study various factors that determine the improvement in FBM angle and Pirani score in patients treated by the Ponseti technique.

Materials and methods: This prospective observational study was conducted after obtaining ethical clearance, and 42 children with CTEV (60 feet) were enrolled. Various parameters affecting FBM angle and Pirani scoring were recorded for each individual patient on a predesigned proforma. Patients were managed by serial manipulation and casting using the Ponseti technique with weekly follow-ups, and changes in FBM angle and Pirani score were recorded. The result was analyzed, and determinants of improvement in FBM angle, Pirani scoring, and recurrence were compared and reported.

Results: Significant factors affecting FBM angle were age at treatment commencement, severity at presentation, and outside treatment. However, only severity at presentation emerged as the most significant variable. Significant factors affecting Pirani score improvement were age at the start of treatment, severity at presentation, and parent education. However, severity at presentation was the most significant variable. The recurrence of clubfoot was significantly associated with severity at presentation, education of parents, weekly visit compliance, and compliance with orthosis.

Conclusion: The identification of independent risk factors, including various sociodemographic factors affecting CTEV treatment outcomes, can allow clinicians to intervene at various levels of management, including parental counselling and socio-economic support, as measures to enhance compliance and ascertain more promising outcomes.
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NewsBot · Jan 30, 2025

Factors influencing recurrence in clubfoot treatment with the Ponseti method in children under 5 years of age: a scoping review
Esteban Portilla-Rojas et al
J Pediatr Orthop B. 2025 Mar 1;34(2):177-184.

Clubfoot (CF) is one of the most common musculoskeletal congenital abnormalities. Despite having optimal methods for its treatment, factors associated with the recurrence of CF treatment continue to be a topic of interest. The aim of this study was to perform a scoping review of the existing literature on factors associated with the recurrence of CF following treatment with the Ponseti method in children under 5 years of age. A scoping literature review was conducted in March 2024 using PubMed and Embase databases, and a structured research strategy. Screening of articles was performed by independent reviewers to ensure the inclusion of all pertinent studies. Considering inclusion and exclusion criteria, a final of 18 articles were included which encompassed factors associated with the recurrence of CF after treatment with the Ponseti method. The Ponseti method has demonstrated a high success rate in achieving CF correction. Various factors come into play regarding favorable outcomes and recurrence cases. The identified factors were initial severity scores for CF, age at the beginning of treatment, correct identification of idiopathic CF and complex CF, neuromuscular imbalance, poor nutritional status, noncompliance for the brace use, and the availability of a specialized attention center that ensured proper Ponseti method application and treatment adherence. Our findings highlight the importance of identifying different factors associated with the recurrence of CF following treatment with the Ponseti method, where timely intervention could minimize the risk of recurrence and achieve favorable outcomes.
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NewsBot · Apr 4, 2025

Necessity of Tendoachilles Tenotomy in Patients With Congenital Talipes Equinovarus (CTEV) Treated Using the Ponseti Technique: A Prospective Cohort Study
Asif Afridi et al
Cureus. 2024 Dec 8;16(12):e75324.

Aim: This study aims to determine how often Achilles tenotomy is performed on patients who have congenital talipes equinovarus (CTEV) and have been managed with Ponseti serial casts.

Materials and methods: This prospective cohort study took place from November 2021 to May 2023 in the orthopedic unit of Hayatabad Medical Complex, Peshawar, Pakistan. About 38 pediatric patients with CTEV, who received treatment in the form of Ponseti casting, were enrolled in the study. Clinicodemographic data of the patients were recorded. Informed consents were taken prior to enrollment.

Results: Using the Ponseti casting method, 56 feet in 38 pediatric patients with CTEV, were treated. Of 38 patients, 27 (71.05%) were male and 11 (28.94%) were female. Fourteen (36.84%) out of 38 had a right foot, 6 (15.7%) had a left foot, and 18 (47.36%) had bilateral foot involvement. The mean age was 8.8±2.5 weeks (ranging from 5 to 13 weeks) when they were subjected to Achilles tenotomy. The initial mean Pirani score was 3±0.74 while the final Pirani score was 1±0.74 after Ponseti casting, showing the efficacy of Ponseti casting correcting the cavus, varus, and adduction components of clubfoot. The mean number of casts was 5±0.84 to correct the aforementioned components of clubfoot. In 34 feet (60.71%) the residual equines deformity was persistent and Achilles tenotomy was done to make the foot plantigrade. In the end, all 38 patients had plantigrade feet.

Conclusion: Equinus deformity was present in over 60% of the patients following Ponseti serial casting, highlighting the need for tendoachilles tenotomy to make the foot plantigrade. A combination of Ponseti casting and tendoachilles tenotomy resulted in plantigrade feet in 100% of patients.
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NewsBot · Jun 5, 2025

The 10-Year Functional Outcome of Ponseti Treatment of Idiopathic and Arthrogrypotic Clubfeet With an Age-Matched Control
Chris Church et al
J Pediatr Orthop. 2025 May 21.

Background: The Ponseti method is accepted as an effective primary conservative treatment for idiopathic clubfoot (IC) using serial casting, percutaneous Achilles tenotomy, and prolonged bracing. The outcomes of its use in treating rigid clubfoot in arthrogryposis are unclear. This study assesses the outcomes of the Ponseti method in children with IC and arthrogrypotic clubfoot at an average age of 10 years.

Methods: Outcomes of the Ponseti method were retrospectively studied in ambulatory children ages 8.0 to 12.9 years in the gait lab between 2004 and 2024. Children were excluded due to the presence of nonidiopathic or nonarthrogryposis-related clubfoot and history of posteromedial release. The Ponseti treatment included serial casting and Achilles tenotomy in infancy, followed by night bracing until age 5 in both cohorts. Clubfoot groups were compared with typically developing children by analyses of foot pressure data, passive range of motion, Gross Motor Function Measure Dimension-D, and Pediatric Outcomes Data Collection Instrument. Surgical history was also recorded. A subsection of these children visited the gait lab at age 4.0 to 6.9 years (2003 to 2021) and data from their visits were abstracted for a longitudinal study.

Results: One hundred seventy-seven children were reviewed (48 with clubfoot associated with arthrogryposis, 129 with IC) with an average age of 9.4±0.9 years. Repeat surgical intervention was used in 33% of IC feet and 44% of arthrogrypotic clubfeet. Residual equinovarus and limitations in range of motion were present in both clubfoot groups compared with typically developing feet (P<0.05). The foot deformity and passive range of motion restrictions were more severe in children with arthrogrypotic clubfeet (P<0.05). The arthrogrypotic clubfoot group additionally exhibited limited gross motor and global function (P<0.001). In 5-year to 10-year comparisons, both subgroups showed more limitations in ankle motion but improvements in dynamic equinovarus deformity and function at age 10 years (P<0.05).

Conclusions: Despite residual deformity, children with idiopathic clubfoot achieve typical functional outcomes through Ponseti treatment. Children with arthrogrypotic clubfeet exhibit functional limitations, but the Ponseti method is effective in improving foot position while minimizing the need for surgical intervention
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NewsBot · Jun 11, 2025

Do cast characteristics influence the post Achilles tenotomy treatment outcomes in Ponseti method?
Dr. Anil Agarwal et al
Journal of Clinical Orthopaedics and Trauma

Background
The post tenotomy Ponseti cast is retained for three weeks. In few children, the cast appear soiled especially at its proximal extent and sometimes, at the knee and foot sections as well. Some of these children manifest deterioration of the previously achieved clinical ankle dorsiflexion. This study aimed at investigating the characteristics of post tenotomy cast at follow up to study their influence on ankle dorsiflexion.
Methods
The study included 25 children with bilateral idiopathic clubfeet under age 1 year treated with Ponseti method who also underwent percutaneous Achilles tenotomy for both feet (50 limbs). The cast characteristics evaluated were extent till groin, knee and ankle intactness along with firmness of plantar surface. Clinical ankle dorsiflexion was measured immediate post tenotomy and at follow up. Odds ratios were calculated to establish relationship between ankle dorsiflexion and cast characteristics
Results
The mean child’s age was 3.7 months. The immediate post tenotomy ankle dorsiflexion was 15.2 degrees and at follow up was 14.2 degrees (p= 0.0029). Sixteen casts (32%) were found short near the groin edge at follow up. Out of these, 9 limbs (56%) had lower ankle dorsiflexion measurements than those achieved immediate post tenotomy. Statistically, the likelihood of lost dorsiflexion was heightened 87 times with recessed groin margin compared to the intact casts (p=0.003). Although the odds ratio of deterioration of ankle dorsiflexion with plantar surface break was even higher (odds ratio 160; p<0.0001), isolated plantar breaks without cast recession near the groin were not observed in any of the limbs.
Conclusions
The deteriorated cast characteristics at follow up may be responsible for loss of achieved ankle dorsiflexion immediate post tenotomy. The post tenotomy cast should be monitored better to keep its integrity and extent intact
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NewsBot · Jun 11, 2025

Scar characteristics of percutaneous Achilles tenotomy in Ponseti Technique-A cross-sectional study
Varun Garg et al
Journal of Clinical Orthopaedics and Trauma Volume 68, September 2025, 103090

Background
Clubfoot, a common birth defect, is treated with the Ponseti method. It involves an intensive phase of weekly casting and Achilles tenotomy as the last step in most of the cases. The tenotomy scar of percutaneous Achilles tenotomy may cause aesthetic concerns that could affect parental satisfaction or impede footwear use. This study aims to objectively evaluate the scar characteristics of percutaneous Achilles tenotomy during Ponseti treatment and parental perception of the same.
Methods
This study enrolled children with idiopathic clubfoot treated by Ponseti protocol with percutaneous Achilles tenotomy before 1 year of age and on bracing protocol between 2 and 4 years. The Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS 2.0) were used to assess scar quality. Complications such as hypertrophy, keloid formation, brace difficulty, footwear difficulty, and walking difficulties were noted.
Results
The study evaluated 82 scars in 50 children (35 males, 15 females). At the final follow-up, most of the scars were close to the normal skin. The mean value of the VSS and overall opinion of the observer and parents regarding the scar was 3.0 ± 1.0, 1.2 ± 0.5 and 2.2 ± 2.1 respectively. All children were able to walk using normal shoes and actively take part in outdoor activities and no complications such as hypertrophic scar or keloid formation were seen.
Conclusion
Percutaneous tenotomy causes minimal scarring and does not interfere with the general functioning of the child. The aesthetic characteristics of the scar are well-accepted by the parents. The use of percutaneous tenotomy should not be limited by the concern of a scar.
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NewsBot · Jun 16, 2025

Clinical and radiographic evaluation of Ponseti method for neonate congenital clubfoot
Hai JiangHai JiangTao Li
Front. Pediatr., 11 June 2025

Objective: The objective of this study was to evaluate the clinical and radiographic outcomes of children with congenital clubfoot following treatment with the Ponseti method.
Methods: We conducted a retrospective analysis of radiographic data from 20 children (12 males and 8 females) aged between 2 years 6 months and 7 years who underwent Ponseti method treatment for congenital clubfoot. The beginning treatment age was below 4 weeks after birth. The study included bilateral ten cases and unilateral ten cases. There were 20 cases which age matched normal feet in control group. The Pirani scoring system was used to assess the severity of the clubfeet. The average Pirani score was 5.5 (4.5–6). Radiographic measurements were taken from post-treatment images and compared to normative values. Talar length, talar height, calcaneus inclination angle, Meary's angle, and talocalcaneal angle were measured. Paired t-tests and effect size (r) were used to evaluate the effectiveness of the treatment.

Results: All the patients were followed up at average 44 months (30–84 months). Functional, plantigrade feet with adequate mobility were achieved in all patients. The average Pirani score was 0.075 (0–0.5) at the end of the follow- up. Bilateral clubfoot exhibited significantly shorter talar length, lower talar height, smaller talocalcaneal angles, smaller calcaneus inclination angles and smaller Meary's angles compared to normal feet. Unilateral clubfeet exhibited a significantly greater talar height and a slightly higher calcaneus inclination angles compared to bilateral clubfeet. There were no significant differences observed in talar length, talocalcaneal angle, or Meary's angle between bilateral and unilateral clubfoot groups.

Conclusions: The Ponseti method has been proven to be highly effective in achieving functional correction in children with congenital clubfoot. However, radiographic images in this study revealed differences in tarsal bone morphology. Therefore, further long-term studies are necessary to evaluate the durability of these corrections and their impact on functional mobility in adulthood. The future study should also aim to clarify the causes of observed morphological alterations.
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NewsBot · Jun 19, 2025

Pearls to Address Challenges in Initial Casting Treatment for Idiopathic Clubfoot
Christopher Williams, BS ∙ Patrick Nian, BA ∙ Ruth H. Jones, BS ∙ Amith Umesh, BA ∙ David M. Scher, MD ∙ Shevaun M. Doyle, MD doyles@hss.edu
Source

Ponseti casting has established itself as the gold standard for the treatment of clubfoot over the past 30 years due to its outstanding short- and long-term outcomes. This method requires a nuanced technique throughout each phase of correction, involving gentle manipulation of the appropriate anatomic regions of the foot. Certain “pearls” should be considered to optimize this process, including minimizing infantile distress, deliberately choosing casting and padding material, and planning the casting timeline. Clubfoot providers should be aware of the “pitfalls” associated with inadequate execution of casting, including cast slippage, overcorrection, skin manifestations, and residual deformity.
Key Concepts
(1)
Ponseti casting addresses all elements of clubfoot (midfoot cavus, forefoot and midfoot adduction, hindfoot varus, and equinus) in a systematic way that respects the natural kinematics of the foot.
(2)
Ponseti casting requires the use of gentle manipulation through the appropriate anatomical regions of the foot to ensure adequate correction, minimize residual deformity, and avoid iatrogenic deformity.
(3)
Implementing efforts to minimize infantile distress, choose appropriate cast and padding materials, provide a succinct casting plan, and optimize brace tolerance will maximize the success of the Ponseti method.
(4)
Common undesirable consequences of casting include cast slippage, skin maceration, and iatrogenic deformities, such as tarsometatarsal abduction, hindfoot valgus, rocker bottom foot, and flat-top talus.
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NewsBot · Jun 19, 2025

The 10-Year Functional Outcome of Ponseti Treatment of Idiopathic and Arthrogrypotic Clubfeet With an Age-Matched Control
Church, Chris MPT; Wang, Nicole BS; Butler, Stephanie PT, DPT; Salazar-Torres, Jose J. PhD; Henley, John PhD; Miller, Freeman MD; Carlin, Nancy MBA; Donohoe, Maureen PT, DPT; Nichols, L. Reid MD
Journal of Pediatric Orthopaedics ():10.1097/BPO.0000000000003007, May 21, 2025. | DOI: 10.1097/BPO.0000000000003007

Background:

The Ponseti method is accepted as an effective primary conservative treatment for idiopathic clubfoot (IC) using serial casting, percutaneous Achilles tenotomy, and prolonged bracing. The outcomes of its use in treating rigid clubfoot in arthrogryposis are unclear. This study assesses the outcomes of the Ponseti method in children with IC and arthrogrypotic clubfoot at an average age of 10 years.
Methods:

Outcomes of the Ponseti method were retrospectively studied in ambulatory children ages 8.0 to 12.9 years in the gait lab between 2004 and 2024. Children were excluded due to the presence of nonidiopathic or nonarthrogryposis-related clubfoot and history of posteromedial release. The Ponseti treatment included serial casting and Achilles tenotomy in infancy, followed by night bracing until age 5 in both cohorts. Clubfoot groups were compared with typically developing children by analyses of foot pressure data, passive range of motion, Gross Motor Function Measure Dimension-D, and Pediatric Outcomes Data Collection Instrument. Surgical history was also recorded. A subsection of these children visited the gait lab at age 4.0 to 6.9 years (2003 to 2021) and data from their visits were abstracted for a longitudinal study.
Results:

One hundred seventy-seven children were reviewed (48 with clubfoot associated with arthrogryposis, 129 with IC) with an average age of 9.4±0.9 years. Repeat surgical intervention was used in 33% of IC feet and 44% of arthrogrypotic clubfeet. Residual equinovarus and limitations in range of motion were present in both clubfoot groups compared with typically developing feet (P<0.05). The foot deformity and passive range of motion restrictions were more severe in children with arthrogrypotic clubfeet (P<0.05). The arthrogrypotic clubfoot group additionally exhibited limited gross motor and global function (P<0.001). In 5-year to 10-year comparisons, both subgroups showed more limitations in ankle motion but improvements in dynamic equinovarus deformity and function at age 10 years (P<0.05).
Conclusions:

Despite residual deformity, children with idiopathic clubfoot achieve typical functional outcomes through Ponseti treatment. Children with arthrogrypotic clubfeet exhibit functional limitations, but the Ponseti method is effective in improving foot position while minimizing the need for surgical intervention.
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NewsBot · Jun 23, 2025

Predisposing Factors for Recurrence Idiopathic Club Foot After Successful Ponseti Treatment at Tikur Anbesa Specialized Hospital
Adamu Belete Genet et al
Source

Background: Idiopathic clubfoot is treated with the Ponseti treatment all over the world; yet, the deformity's recurrence is a major complication and not studied in Ethiopia. This research aimed to determine predisposing factors for recurrence of idiopathic club foot after successful ponseti treatment. The objective of this study is to asses
predisposing factors for idiopathic club foot recurrence following successful ponseti technique correction.
Method: All children with corrected idiopathic club foot who started abduction brace and on follow up from September 2021 to September 2023 after Ponseti treatment who fulfilled the eligibility criteria were included. From
medical and club foot register and telephone call interview, data were collected and analyzed by SPSS version 29
software. Descriptive statistics, bivariable and multivariable analysis were used.
Result: There were 104 patients (136 feet) followed for average of 3.4 years. Thirty-two (31.7%) were right side
clubfoot, 38(36.5%) were left side and 33(31.7%) were bilateral. Sixty-six (63.5%) children were males. There
were 39(28.7%) feet which had recurrence. Place of residence shows 62(59.6%) were from urban. Chi-square
tests found associations between recurrence and, awareness level of treatment (p=0.0001), parent’s education
status (p=0.002), job (p=0.003), satisfaction of parent with treatment (p=0.004), poor compliance (p<0.001), discomfort during wearing brace (p=0.01), pretreatment Pirani scores (p<0.001) and longer follow up age
(p=0.014). Logistic regression identified pretreatment Pirani score (p=0.024), and poor brace compliance
(p=0.022) had major predictive significance for recurrence.
Conclusion. Pretreatment Pirani score and poor brace compliance are independent significant predictors of recurrence.
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NewsBot · Jun 24, 2025

Considerations for Improving Accessibility to the Ponseti Method for Idiopathic Clubfoot Treatment
Burkett, Natalie,
(2025). Capstone Showcase. 94

Idiopathic clubfoot is one of the most common musculoskeletal deformities worldwide, affecting about one in 1,000 live births. Clubfoot has four characteristic deformities: equinus, heel varus, midfoot adductus, and cavus. Without proper and timely treatment, patients may develop progressive, painful, disabling, and permanent lower extremity deformities, hindering them from meeting developmental milestones, walking and staying active, performing tasks of employment, and living a satisfactory, pain-free quality of life. The gold-standard treatment is the Ponseti Method, which involves several weeks of in-office appointments for gentle manipulation and serial plaster casting, a percutaneous achilles tenotomy, and a prolonged multi-year long bracing phase. Even with treatment, the deformity can recur for numerous reasons. An opportunity for improving patient care and quality of life arises in identifying psychological, social, and economic barriers to care for these patients and implementing programs to help alleviate them. This article aims to elucidate some of these potential barriers and provide evidence-based recommendations for healthcare providers to mitigate them.
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NewsBot · Jun 26, 2025

Clinical and radiographic evaluation of Ponseti method for neonate congenital clubfoot
Hai Jiang , Tao Li
Front Pediatr. 2025 Jun 11:13:1619908.

Objective: The objective of this study was to evaluate the clinical and radiographic outcomes of children with congenital clubfoot following treatment with the Ponseti method.

Methods: We conducted a retrospective analysis of radiographic data from 20 children (12 males and 8 females) aged between 2 years 6 months and 7 years who underwent Ponseti method treatment for congenital clubfoot. The beginning treatment age was below 4 weeks after birth. The study included bilateral ten cases and unilateral ten cases. There were 20 cases which age matched normal feet in control group. The Pirani scoring system was used to assess the severity of the clubfeet. The average Pirani score was 5.5 (4.5-6). Radiographic measurements were taken from post-treatment images and compared to normative values. Talar length, talar height, calcaneus inclination angle, Meary's angle, and talocalcaneal angle were measured. Paired t-tests and effect size (r) were used to evaluate the effectiveness of the treatment.

Results: All the patients were followed up at average 44 months (30-84 months). Functional, plantigrade feet with adequate mobility were achieved in all patients. The average Pirani score was 0.075 (0-0.5) at the end of the follow- up. Bilateral clubfoot exhibited significantly shorter talar length, lower talar height, smaller talocalcaneal angles, smaller calcaneus inclination angles and smaller Meary's angles compared to normal feet. Unilateral clubfeet exhibited a significantly greater talar height and a slightly higher calcaneus inclination angles compared to bilateral clubfeet. There were no significant differences observed in talar length, talocalcaneal angle, or Meary's angle between bilateral and unilateral clubfoot groups.

Conclusions: The Ponseti method has been proven to be highly effective in achieving functional correction in children with congenital clubfoot. However, radiographic images in this study revealed differences in tarsal bone morphology. Therefore, further long-term studies are necessary to evaluate the durability of these corrections and their impact on functional mobility in adulthood. The future study should also aim to clarify the causes of observed morphological alterations.
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NewsBot · Jun 29, 2025

Repeating Ponseti method for treating relapsed idiopathic congenital talipes equinovarus in children less than two years of age: a prospective study
Khalaf Fathy Elsayed Ahmed et al
BMC Musculoskelet Disord. 2025 Mar 15;26(1):263.

Background: Various conservative and non-conservative methods have been debated for their effectiveness in treating relapsed idiopathic congenital talipes equinovarus (CTEV). The aim of this work was the assessment of repeating Ponseti method in management of relapsed idiopathic CTEV in children less than two years of age.

Methods: This prospective study was carried out on 50 clubfeet in 33 children aged 10 months - two years, who had relapsed idiopathic CTEV after documented complete correction of the initial deformity with Ponseti method and initiation of a bracing protocol, between April 2022 and April 2024. Before, during, and after the last cast removal, as well as at the end of follow-up, the Pirani scoring system was utilized to evaluate each clubfoot.

Results: The mean age was 12.5 ± 6.08 months. Sex was male in 26 (52%) patients. The side was right in 28 (56%) patients. Pirani score was significantly lower after the last cast removal and at the end of follow up than before treatment (P < 0.001).

Conclusion: Relapsed idiopathic CTEV in children less than two years of age were effectively managed with the repeating of Ponseti method.
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NewsBot · Jul 2, 2025

Midterm Results of Ponseti Management for Idiopathic Congenital Clubfoot at a Single Tertiary Center
Lulu Damsas et al
Ann Afr Med. 2025 Jun 30.

Background: Congenital talipes equinovarus, also known as clubfoot, is one of the most common deformities of the musculoskeletal system in newborns. Although Kites developed one of the first nonsurgical methods, the Ponseti method is more popular, where counterpressure is applied on the talar head.

Methodology: Two hundred and twelve idiopathic clubfeet were treated (84 bilateral and 44 unilateral) with the Ponseti method of casting; tenotomy was considered when the midfoot Pirani score was 0. Tenotomy was followed by casting for 3 weeks. The final functional outcome was assessed at 5 years (60 months) with Richard scoring.

Results: The average number of casts applied for complete correction was 7.31, and 86.3% of the cases required tenotomy. Richard's scoring, one of the better midterm functional scores, obtained a good result in 94% of cases.

Conclusion: Early intervention with the Ponseti method results in a plantigrade, functional foot that resembles a normal foot. This method is not only safe but also effectively reduces the economic and social burdens associated with clubfoot.
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NewsBot · Jul 25, 2025

Long-Term Follow-Up of Congenital Clubfoot Treated
with Ponseti Method: A Cross-Sectional Study
Gianluca Testa et al
Source

Background/Objectives: Commonly known as clubfoot, congenital talipes equinovarus (CTEV) is a
structural deformity characterized by cavus, adductus, varus, and equinus (CAVE) positioning of the
foot. Idiopathic clubfoot requires prompt treatment to achieve functional, pain-free, and aesthetically
normal feet. The Ponseti method is a conservative treatment involving serial manipulation, casting,
and Achilles tenotomy, which has demonstrated high success rates. This study evaluated 10 years of
experience using the Ponseti method. Methods: A total of 91 patients (146 feet) with idiopathic
clubfoot were treated between 2011 and 2023. The severity of deformities was assessed using the
Pirani score. Data collection included demographic details, number of casts, tenotomy procedures,
adherence to the Denis Browne brace protocol, and complications. A retrospective and follow-up
analysis was conducted with 72 patients (118 feet) who met the minimum follow-up requirement of
12 months (mean follow-up: 54.15 months). Outcomes were measured using the Ponseti functional
scoring system. Results: Initial correction of deformities was achieved in all 91 patients (100%). The
average number of casts applied was 9.51 per patient. Percutaneous Achilles tenotomy was
performed in 91.21% of cases. Relapse occurred in 22.2% of patients, which required additional
treatments. The outcomes were excellent in 77.7% of cases, good in 13.88%, fair in 6.94%, and poor in
1.38%. Conclusions: The Ponseti method is effective for idiopathic clubfoot treatment and achieves
high rates of initial correction, favorable long-term outcomes, and minimal complications. These
results confirm its reliability and align with previously reported success rates
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NewsBot · Jul 27, 2025

Assessing the five-year results of the Ponseti technique for treating clubfoot:
A retrospective study
Manzoor et al
Sri Lanka Journal of Child Health, 2025; 54(1): 40-45

Introduction: Among non-surgical interventions for
clubfoot, the Ponseti method is the preferred approach.
Objectives: To evaluate the five-year outcomes of the
Ponseti technique.
Method: A retrospective analysis was done on infants
with idiopathic clubfoot from December 2017 to
December 2022. The progression was assessed by
correlating the mean Pirani scores at registration (P1), the
onset of bracing (P2), and the conclusion of treatment
(P3), or the latest visit during treatment (P4).
Results: Of the 950 infants included in study, 21.1%
completed treatment and 78.9% were in the bracing phase.
Majority (63.3%) were male and unilateral clubfoot was
observed in over 70% of cases; 15.8% had a family history
of clubfoot, and 26.4% experienced birth complications.
Mean casting score was 6.82±1.04, with 17.7%
experiencing casting-related complications; 76.8% infants
showed compliance with brace usage and relapse rate was
21.5%. A significant reduction in Pirani scores was
observed from P1 to P2, and further to P3/P4 (p <0.05).
Conclusions: Effective management of clubfoot
necessitates prolonged treatment duration for optimal
outcomes. Ponseti technique had a success rate of 78.5%.
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NewsBot · Jul 27, 2025

Repeating Ponseti method for treating relapsed idiopathic congenital talipes equinovarus in children less than two years of age: a prospective study
Khalaf Fathy Elsayed Ahmed, Ashraf Rashad Marzouk & Marwan Shams Eldin
BMC Musculoskeletal Disorders

Background
Various conservative and non-conservative methods have been debated for their effectiveness in treating relapsed idiopathic congenital talipes equinovarus (CTEV). The aim of this work was the assessment of repeating Ponseti method in management of relapsed idiopathic CTEV in children less than two years of age.

Methods
This prospective study was carried out on 50 clubfeet in 33 children aged 10 months - two years, who had relapsed idiopathic CTEV after documented complete correction of the initial deformity with Ponseti method and initiation of a bracing protocol, between April 2022 and April 2024. Before, during, and after the last cast removal, as well as at the end of follow-up, the Pirani scoring system was utilized to evaluate each clubfoot.

Results
The mean age was 12.5 ± 6.08 months. Sex was male in 26 (52%) patients. The side was right in 28 (56%) patients. Pirani score was significantly lower after the last cast removal and at the end of follow up than before treatment (P < 0.001).

Conclusion
Relapsed idiopathic CTEV in children less than two years of age were effectively managed with the repeating of Ponseti method.
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NewsBot · Aug 13, 2025

Treatment of Congenital Talipes Equinovarus using accelerated Ponseti method by fast casting and needle Tenotomy
Abdullah Abdalrahim Taha et al
International Journal of Medical Arts

Introduction: Congenital Talipes Equinovarus (CTEV) or clubfoot is a common orthopedic deformity that if untreated, leads to significant functional impairment. The Ponseti method, a non-surgical approach involving gentle manipulations, serial casting, and often percutaneous Achilles tenotomy, has become the gold standard due to its effectiveness in correcting the deformity while preserving the foot function. An accelerated Ponseti method aims to reduce treatment duration.

Aim of the Work: This study aims to evaluate the efficacy and safety of the accelerated Ponseti technique in managing the clubfoot among 20 infants under three months of age, treated at the Orthopedic Department, Al-Azhar University Hospital in Damietta, Egypt.

Methods: A prospective clinical trial was conducted from March 2024 to March 2025. Inclusion criteria were infants under three months with idiopathic clubfoot, no prior surgery, and no neurological or syndromic anomalies. The Ponseti technique involved daily manipulations and above-knee casting until 50° abduction was achieved. Percutaneous Achilles tenotomy was performed for residual equinus in most cases. Statistical analysis used SPSS version 26, with a p-value < 0.05 considered significant. Ethical approval and informed consent from guardians were obtained.

Results: The study included 20 infants (average age 2.1 months; 60% male; 35% bilateral involvement). Initial Pirani scores averaged 5.2 at presentation, improving to 0.9 (an 82.3% improvement). The average number of casts was 5.6, with intervals of 6 days. Sixty percent of patients required a tenotomy, typically around 2 months of age. Complications were low (15%), primarily mild discomfort (10%).

Conclusion: The accelerated Ponseti method is a safe, effective, and feasible approach for treating congenital clubfoot in infants, particularly in resource-limited settings. It demonstrates high correction rates, low complication and relapse rates, and high parental satisfaction. Early treatment initiation within the first three months is crucial for maximizing outcomes and effectively managing moderate to severe deformities.
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NewsBot · Aug 13, 2025

Radiological hindfoot abnormalities in the Ponseti corrected clubfoot followed long-term
Agarwal, Anil; Sharma, Lokesh; Sachdeva, Kishmita; Upadhyay, Ashish; KS, Ankitha; Garg, Varun
Journal of Pediatric Orthopaedics B ():10.1097/BPB.0000000000001277, August 05, 2025. | DOI: 10.1097/BPB.0000000000001277

We investigated to what extent the Ponseti technique is successful in radiologically aligning the deformed foot when the deformity was clinically corrected. This prospective study radiologically evaluated Ponseti-treated clubfoot children (Pirani score zero) at a minimum follow-up of 5 years. The radiographs obtained were foot anteroposterior and lateral views (standing views). The angles evaluated in the anteroposterior view were the talocalcaneal and the talus first metatarsal angle. In the lateral view, calcaneal fifth metatarsal, talocalcaneal, talus first metatarsal, tibiocalcaneal, and calcaneal pitch angles were measured. The measured radiological angles were statistically compared to the unaffected feet of the unilateral cases. The mean age of initial treatment for 91 enrolled children (unilateral 37; bilateral 54) was 4 months, and the mean follow-up was 7.2 years. The radiographs revealed similarities for the treated (n = 145) and unaffected feet (n = 37) for two angles (talocalcaneal and talus first metatarsal) evaluated in the anteroposterior view, indicating corrected hindfoot varus and midfoot adduction. Again, the calcaneal fifth metatarsal, talus first metatarsal, and calcaneal pitch angles matched for both feet, indicating a completely corrected cavus. There were, however, significantly lower talocalcaneal (mean 28.1 degrees vs. 32.9 degrees in the unaffected feet) and higher tibiocalcaneal angles (76.5 degrees vs. 72 degrees in the unaffected feet) in the lateral projection of the treated clubfeet, indicating the presence of residual hindfoot abnormalities. The radiological measures in the successfully treated clubfeet matched those of unaffected feet. The exceptions were abnormal lateral talocalcaneal and tibiocalcaneal angles. These might indicate the presence of a certain amount of subclinical hindfoot equinus in the treated children.
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NewsBot · Aug 20, 2025

A Prospective Study of the Clinical Outcome of Deformity Correction by Ponseti Technique in Idiopathic Clubfoot
Madhusudan Hanumanthappa et al
Source

Background: The term “Talipes Equinovarus” is derived from Latin language, Talus means ankle, Pes means foot and equinus means horse like (plantar flexed) and varus means adducted and inverted. There are studies mentioning that the incidence of clubfoot is increasing, making it a challenge for us to treat it with more specific and accurate methods. Materials and Methods: A Prospective study of 60 cases of CTEV treated by Ponseti technique at Department of Orthopedics, J.J.M. Medical College, Davanagere were included in the study. Each patient was followed up regularly weekly during treatment and monthly after completion of treatment. The severity of foot deformities was graded as per Pirani’s scoring system before treatment, and at follow up and results were assessed. Results: Out of 60 patients, good results were obtained in 54 patients.6 patients developed recurrence of the deformity due to non-compliance with Dennis- Brown splint. Conclusion: The Ponseti method is a safe and effective treatment for congenital idiopathic clubfoot and decreases the need for extensive corrective surgery. There is high a level of parent satisfaction regarding the correction of deformity. Non-compliance with orthotics has been found to be the main factor causing failure of the technique.
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NewsBot · Aug 20, 2025

Shorter Night Splinting by a Modified Ponseti Method With Similar Foot-Function and Health-Related Quality of Life
Angela Seidel et al
Cureus. 2025 Mar 8;17(3):e80260.

Background The Ponseti method is the most frequent method for clubfoot treatment. It includes a six-year night-splinting period, which is difficult to comply with. The objective of this study is to evaluate the clinical outcomes, recurrence rates, and patient-reported health-related quality of life following a modified Ponseti method with reduced night splinting duration. Methods We analyzed 107 children (77 boys, 30 girls, 152 clubfeet) who were treated for idiopathic clubfoot from January 1994 to January 2015. The initial treatment started at a mean age of 9.2 days. Long-leg Soft Casts TM3 were applied until the desired position of the foot was achieved. At a mean age of 3.2 months, the residual deformity was corrected surgically. We assessed the clinical outcome by chart review and the functional outcome by a questionnaire that included the disease specific instrument (DSI) and the health-related quality of life assessed by the pediatric quality of life inventory (PedsQL™). Results In 101 patients (92.7%) and 142 feet (93.4%), we had a clinical follow-up at a mean age of 7.39±4.9 years. A Denise Brown splint or a unilateral orthosis was applied for a mean period of 7.8±4.8 months over the whole day and an additional 17.3 ±16.3) nights only. At a mean follow-up of 10.0±SD 6.2 years, 82.2% of patients returned the questionnaires. The mean DSI was 74.8±17.5. The mean overall PedsQL™ was 87.8±12.6. The PedsQL™ functional component score showed a mean of 89.4±5.6, and the PedsQL™ social component score a mean of 86.9±13.5. Ten (9.3%) patients had a bilateral, and 18 (16.8%) patients had a unilateral relapse. Conclusions Achilles tendon lengthening (ATL) and limited posterior release, followed by a reduced period of splinting of 2.1 years, provide similar results compared to the original Ponseti method.
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NewsBot · Sep 5, 2025

Kinematic characterization of residual deformities in idiopathic clubfoot initially treated with the Ponseti method: Gait analysis using the Heidelberg Foot Model
Qiuyue Chen et al
J Child Orthop. 2025 Sep 2:18632521251369353.

Purpose: This study aimed to investigate foot kinematics during gait in individuals with idiopathic clubfoot initially treated with the Ponseti method, focusing on clubfoot-specific deformities, to improve the understanding of posttreatment functional impairments.

Methods: In this prospective cohort study, 23 patients with treated idiopathic clubfoot (34 feet) were compared with 15 age-matched healthy controls (30 feet). Gait analysis was performed using the Heidelberg Foot Model. To characterize residual clubfoot deformities, selected kinematic parameters included medial arch and subtalar angles, as well as intersegmental angles between hindfoot-shank and forefoot-hindfoot, based on more functional joint centers. Within the patient group, potential influence of additional surgical interventions was explored.

Results: Compared with controls, treated idiopathic clubfoot exhibited significant reductions in hindfoot sagittal and transverse range of motion, forefoot sagittal range of motion, and medial arch mobility. Equinus deformity was not present posttreatment, as dorsiflexion metrics during stance did not differ significantly. However, plantarflexion range of motion during the transition to swing was reduced. In addition, treated idiopathic clubfoot showed persistent subtalar inversion and hindfoot varus, increased mid-stance adductus in both hindfoot and forefoot, and pronounced arch stiffness during transition to swing. Within the patient group, ankle and subtalar capsulotomy was associated with increased medial arch cavus.

Conclusion: Patients with treated idiopathic clubfoot exhibit a functionally stiffer foot with altered alignment during gait, contributing to impaired limb advancement. The results expand the understanding of residual clubfoot deformities and highlight the importance of detailed functional assessment posttreatment, providing a foundation for future research.
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NewsBot · Sep 12, 2025

Plaster of Paris versus semirigid fiberglass casting in the Ponseti method for idiopathic clubfoot: a systematic review and a meta-analysis
Cosentino, Andreaa,b; Berger, Wilhelma
Journal of Pediatric Orthopaedics B ():10.1097/BPB.0000000000001286, August 26, 2025. | DOI: 10.1097/BPB.0000000000001286

Plaster of Paris (POP) is traditional for Ponseti treatment of idiopathic congenital talipes equinovarus (CTEV), but semirigid fiberglass (SRF) is an alternative. This systematic review and meta-analysis compare POP and SRF outcomes. We searched PubMed, Scopus, Cochrane, and EMBASE up to 5th April 2025 for randomized controlled trials (RCTs) and quasi-RCTs comparing POP versus SRF for initial Ponseti treatment of idiopathic CTEV. Eligible studies reported on the number of casts, clinical scores (Dimeglio/Pirani), relapse or skin complications. Risk of bias was assessed using the Cochrane RoB tool. Data were pooled using random-effects meta-analysis [mean difference (MD) for continuous, risk ratio (RR) for binary outcomes]. Four studies (two RCTs, one prospective, one retrospective; 454 feet) met inclusion criteria. Study quality varied. No significant difference was found in the mean number of casts [MD: 0.34, 95% confidence interval (CI): −8.80 to 9.48; two studies, I² = 70.6%], relapse rates (RR: 1.41, 95% CI: 0.04–50.93; two studies, I² = 0.0%), or skin lesions (RR: 0.68, 95% CI: 0.31–1.50; two studies, I² = NA). Evidence certainty was low due to heterogeneity and limited studies. Clinical score analysis was limited by differing scales and missing data; SRF consistently received higher parental satisfaction ratings. Based on limited, low-certainty evidence, no significant difference in clinical efficacy (casts, relapse, skin lesions) was found between POP and SRF. SRF offers advantages in parental satisfaction. Limitations include heterogeneity, few studies per outcome, and inconsistent reporting. While POP is cost-effective, SRF is a viable alternative. Further high-quality RCTs are needed.
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NewsBot · Dec 20, 2025

Outcome of the Ponseti Method for Treatment of Idiopathic Congenital Clubfoot
Raja Muhammad Mussab et al
Cureus. 2025 Feb 20;17(2):e79387.

Introduction Idiopathic congenital clubfoot is a complex deformity that requires treatment to reduce the deformity to a flexible, plantigrade, and painless foot. The Ponseti method has gained international prominence due to its effectiveness and reduction in the need for surgical procedures. The aim of this study is to determine the outcome of the Ponseti method in patients with idiopathic congenital clubfoot, which will generate local evidence. Methods A descriptive cross-sectional study was conducted in the Department of Orthopaedics at Jinnah Postgraduate Medical Centre (JPMC) Karachi over a six-month period, from September 6, 2022, to March 7, 2023. Participants were included if they were children under three years of age, presented with idiopathic congenital clubfoot, and had a Pirani score of 2 or higher. The outcome was assessed immediately after the completion of treatment and after four months by using the Pirani score. Results were graded as excellent (Pirani score <1), good (score 1-2), and poor (score >2). Baseline demographic characteristics and Pirani score were recorded immediately after completion of treatment and after four months. Effect modifiers such as age, gender, weight, residence, and baseline Pirani score were controlled through stratification. Post-stratification Chi-square test was applied taking p-value ≤0.05 as significant. Results Of 91 neonates, the mean age of the neonates was 1.44 ±0.66 years. There were 51 (56%) males and 40 (44%) females. The Pirani score immediately after the treatment was 1.61 ± 1.38. Excellent outcome immediately after the treatment was observed in 43 (47.3%), good in 26 (28.6%), and fair in 22 (24.2%). At four months follow-up, the Pirani score was 0.91 ± 0.81. Excellent outcome immediately after the treatment was observed in 63 (69.2%), good in 23 (25.3%), and fair in five (5.5%). Conclusion The Ponseti method is an effective and reliable treatment for idiopathic congenital clubfoot at a tertiary care hospital. The intervention achieves marked improvement in deformity correction and also sustains clinical benefits over the short-term follow-up period. Future research with extended follow-up periods and broader sample sizes is needed to further evaluate long-term functional outcomes.
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NewsBot · Jan 19, 2026

Accelerated versus standard ponseti method for idiopathic clubfoot: A systematic review and meta-analysis of efficacy and safety
Rafael Llombart-Blanco et al
Foot Ankle Surg. 2026 Jan 15:S1268-7731(26)00001-9.

Background: The Ponseti method is the gold standard for managing congenital idiopathic clubfoot. Recent modifications, such as the accelerated Ponseti protocol, aim to shorten treatment duration without compromising outcomes. However, evidence comparing its efficacy and safety to the standard protocol remains inconclusive.

Objective: To compare the efficacy and safety of the accelerated versus standard Ponseti method in the treatment of congenital idiopathic clubfoot.

Methods: Eligible studies included randomized controlled trials and prospective comparative studies involving patients with idiopathic clubfoot treated with either accelerated or standard Ponseti methods.

Results: Sixteen studies involving 957 patients were included. There was no significant difference between groups in post-treatment Pirani score [MD = -0.03, 95 % CI (-0.24-0.17), p = 0.75], tenotomy rate [RR = 1.04, 95 % CI (0.99-1.09), p = 0.14], or relapse rate [RR = 1.11, 95 % CI (0.80-1.55), p = 0.54]. However, the accelerated group required slightly more casts [MD = 0.38, p = 0.032] but achieved significantly shorter treatment duration [MD = -20.43 days, p < 0.001]. Subgroup and sensitivity analyses confirmed the robustness of the findings. No major methodological flaws were detected, though blinding was generally lacking.

Conclusion: The accelerated Ponseti method is as effective and safe as the standard protocol, with the advantage of significantly shorter treatment duration. It may be a preferable alternative in appropriate clinical settings, though standardized implementation and long-term follow-up are recommended.
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Ponseti Method for clubfoot

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Ponseti Method for clubfoot

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Measurement methods for forefoot varus

Dr. Nicholas Romanov's Pose Method of Running

Looking for Forensic Podiatry: Principles and Methods, Second Edition

LQDCELL Method from Puma

Surgery Versus Nonsurgical Methods in Treating Neuropathic Plantar Forefoot Ulcers

Lacuna method of treatment for onychomycosis

Slower runners benefit most from elite methods

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