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 at 10:02 PM

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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Ponseti Method for clubfoot

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Ponseti Method for clubfoot

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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

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Slower runners benefit most from elite methods

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