Clubfoot correction is complete once the foot is corrected with casting, and then the foot must be braced with an orthosis consisting of two shoes attached by a bar, called a Foot Abduction Brace (FAB), more commonly known as BnB (Boots & Bar).
This brace is worn for 23 hours a day for the first three months, and thereafter during nights and naps. These hours gradually reduce as naps reduce over the first year until the brace is worn only 12-14 hours a day, often only at night until the child is 4-5 years old.
Almost all Ponseti Method feet can expect to be fully functional and pain free for a lifetime!
NoSurgery4Clubfoot is dedicated to providing information and resources for parents about the Ponseti Method for correcting clubfoot, with an emphasis on no modification or deviations from Dr. Ignacio V. Ponseti's highly successful method and techniques for correcting clubfoot without major surgery.
Most kids with clubfeet will enjoy a perfectly normal and physically active life just like any other child. The Ponseti Method is what provides this wonderful future for our children, who will become adults someday and need their feet to serve and carry them through day to day life and activities.
Not all feet will remain corrected. Some few feet (5-6%) may relapse despite bracing as the Ponseti Method described.
The clubfoot always wants to relapse, especially during the years of major growth before the age of 7. This is why we brace. Without bracing, almost all clubfeet will relapse.
Bilateral (both) Clubfoot At Birth
Some feet, such as those associated with a syndromic condition, may be more difficult to maintain correction. However that does not mean they can't be initially corrected, nor that they will all have troubles staying corrected.
When we refer to "surgery" on this website, it is in reference to the major invasive surgeries normally reserved for the past such as the Posteriomedial Release (PMR) surgery that was routine for most clubfeet up till the past decade, when the Ponseti Method became the standard of care.
– choose wisely, and never based on "referrals" from OB's or Pediatricians. These are not expert referrals This is the hospital system only. Skilled hands are beyond this small network. Please see the Red Light Green Light Parental Review document. Please ask. We are here.
– consistent bracing for 5-6 years is the key to success
– following the Ponseti Method to a "T" is essential
Bracing is essential to success and actually the most important part of treatment!
Parents can help their child have good feet for a lifetime by being consistent and strict with bracing.
Clubfoot will relapse without bracing.
– once casting is complete, the feet are braced to maintain that correction
– bracing lasts for at least 4-5 years, and some feet may need to be braced longer
– the brace consists of two shoes attached by a bar called a Foot Abduction Brace
– the brace is nicknamed BnB, for "boots & bar"
– bracing with the Foot Abduction Brace (BnB) for long hours, with gradual reduction in the first year,has been shown to help prevent relapse in the first year for most feet
– consistent bracing is essential to success
– bracing is usually 4-5y.
– some feet may need further bracing beyond 5-6 years
– most feet will be fully functional and pain free for a lifetime.
– most feet does not equal all feet.
– 3-5% of feet braced in compliance with the Ponseti Method may need additional treatment
– non-compliant bracing almost always results in the need for further correction, and increases the risk of surgery
know what to look out for.
Not All Doctors Are Created Equal *
Not All Doctors Are Ponseti Method Specialists.
– * this is especially true of many of those claiming to follow the Ponseti Method
– if the *supposed* Ponseti Method isn't working, it's not the Method. It is the technique .
– the Ponseti Method is able to initially correct every clubfoot.
– it's not the Ponseti Method if they change things up and reinvent the wheel. That rarely works.
– in the right hands, EVERY clubfoot can be corrected.
– if your doctor says it can't be corrected without major surgery, find another doctor who has the skills to correct special or complex clubfeet. **
– if your provider tells you that your child's feet are "too severe" or "too complex" to be corrected, find another provider for a second, or third, or any additional opinions you need to be comfortable with your child's treatment plan.
– many parents must travel to receive quality and competent care.
– if a provider tells you that your child's feet are corrected and ready for bracing, but you do not see feet that that look almost exactly like a baby's foot should look... find another provider for a second opinion.
clubfoot casts.
– Plaster is the preferred media for Ponseti Method casting.
– Plaster is very moldable and is perfectly suited to correct clubfoot with the Ponseti Method.
– Plaster is relatively inexpensive.
– Fiberglass softcasts(tm) are 12 times more expensive than plaster. This cost increase may be reflected in the charges the provider charges your insurance, or charges to you directly.
– Fiberglass softcasts are not easily molded and they can easily slip because a true 90° bend is difficult to achieve.
– Fiberglass is difficult to mold well around the foot, heel, and ankle. This well molded cast is an essential part of Ponseti Method casting technique, and plays a big part in helping to prevent slips, not to mention the Ponseti manipulations and straightening of the foot.
– Some providers are well skilled with fiberglass softcasts(tm), and can skillfully mold the foot and knee bend. these providers are very rare.
– Casts should be well molded around the heel and foot and they should never look like tubes.Big blob tube casts are incorrect.
– Casts must be high, all the way up to the groin. short casts can cause a cast to slip because the knee can bend inside a little inside the cast if it is short.
– Casts must be bent at the knee at LEAST 90°. this doesn't mean 80° degrees, or 70° degrees. it must be a true 90° bend. Or 100° or more for Atypical or Complex feet. this knee bend is essential to prevent slips.
– The knee bend alone can not prevent a slip. It is a precise combination of specific casting techniques that make the Ponseti Method so successful.
– Plaster casts can also slip if done incorrectly. Plaster casts alone do not assure that your provider is following the Ponseti Method. Many plaster casts are done incorrectly.
– One slip is a mistake that can be correctetd by changing the way the cast is made. More than one slip is a sign the provider is not capable of making the changes that are essential to casting your child's foot properly (find a new provider)
– Slipped casts are an actual emergency and must be removed immediately. Do not leave a slipped cast on your child for any length of time. slipped casts are the leading cause of focf-tx/complex-or-atypical/complex-clubfoot. (find a new provider)
– Toes should be flat and the tips fully outside of the hard edge of the cast, or resting on a "pad". If your child's toes can't be seen, are folded over and smashed, stacking on top of each other, or if the cast at the toes is round instead of flat, this will damage the foot and toes and is a sign of improper casting. Tube shaped casts are commonly round or circle shaped at the toes.
– Mark on the toes with a pen where the edge of cast is to easily recognize a slip. slipped casts must be removed immediately (find a new provider)
– Casts can be uncomfortable at first, but should never be painful. The Ponseti Method consists of "gentle manipulations. It is not ever meant to be painful. (find a new provider)
– Casting a crying child affects the correction.Their muscles are tense and the foot will not respond properly. Dr. Ponseti refused to cast a crying child. He always waited until mama soothed baby, and only when all was well would he proceed with the "gentle manipulations". Many babies sleep through gengle manipulations.
Ponseti casts consist of 5-7 casts changed weekly, for most clubfeet. Please note the well molded shape, the right angle knee bend, and the foot position in each cast.
red flags.
These conditions might indicate that your doctor is modifying the Ponseti Method. You may not be able to make your doctor practice an un-modified Ponseti Method, but you can often find a doctor who doesn't modify the Method.
The following are red flags that the doctor or caregiver is not following the method properly. The result could be that your child's feet are damaged instead of corrected. Red flags like these are all very good reasons to seek out a second opinion from a qualified Ponseti Method practitioner.
Learn about these and other clubfoot treatment red flags here
– Fiberglass "soft" casts
– Slipping casts, any. Plaster can slip as easily as fiberglass.
– Casts not bent at least 90 degrees at the knee.
– Casts that do not allow the toes (all 10) to be free and mobile outside of the cast.
– Casts that make the toes or upper leg swell beyond the confines of the cast
– Casts not following the Ponseti casting guidelines for the first cast.
Red Light Green Light Parental Review Provider List.
In conclusion, this study suggests that early clubfoot recurrence leads to more frequent subsequent recurrence and earlier second recurrence. Patients with early recurrence had comparatively lower outcome scores, primarily due to multiple recurrences. Care providers could use this knowledge to educate parents about the natural history of recurrent clubfeet and emphasize the importance of brace compliance and routine monitoring.
Conclusion: The Ponseti technique is an effective nonsurgical treatment for the overall three-dimensional foot and ankle alignment of Clubfoot. While mild, but statistically significant residual Varus and Adductus deformities were observed in adult clubfoot patients, the overall 3D alignment (FAO) was found to be similar between clubfoot patients and controls. These findings highlight the efficacy of the Ponseti technique and potentially explain the overall good PROs. The results of this study could potentially provide insight into treatment targets that may be applied to help optimize patient outcomes when treating children with Clubfoot in the future.
Conclusion: Ponseti treatment method is a safe and satisfactory method for congenital idiopathic clubfoot with long term effectiveness. Recurrences mainly occurred due to noncompliance with foot abduction brace. Recurrences can also be treated by same method.
Conclusion: The Ponseti technique can improve clubfoot in AMC as measured by the Pirani score. Data shows that early intervention yields better results, with a diminished yet effective ability to elicit change over time.
Conclusion: Besides expediting treatment,
the modified method offers the advantage of hospital supervision, reducing parental stress associated with frequent
travel for plaster changes. Complication rates and recurrence were comparable between the two methods.
Ponseti Casts are very recognizable. If you're lookng for Ponseti Method, look for plaster casts that look like these and provide the same results to the foot.
If your doctor does not achieve these or similar results, seek out a second opinion.
complex and atypical clubfoot.
Learn to understand what complex and atypical clubfoot is, how to recognize it, treat it, and prevent it.
Dre’s parents (Pittsburgh, Pennsylvania) learned about his left clubfoot diagnosis following a 20-week ultrasound. After careful research, they made the decision to travel to seek treatment from world-renowned Dr. Matthew Dobbs, Director of the Dobbs Clubfoot Center and Orthopedic Surgeon at Paley Institute, West Palm Beach, Florida. Dre’s Clubfoot Journey video presents an inside look at the Ponseti Method of treatment performed by Dr. Dobbs and aims to provide insight to families regarding the gold standard of treatment for clubfoot.
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