NoSurgery4Clubfoot is dedicated to providing information 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 methods.
When the Ponseti Method is follwed to a "T", the long term non-surgical success rate can be as high as 97%.
**Not all feet will remain corrected. And some feet, such as those associated with a syndromic condition, may be more difficult to maintain correction long term. However that does not mean they can't be initially corrected, nor that they will all have troubles staying corrected.
***The NoSurgery4Clubfoot definition of "surgery" does not include the Percutaneous Achilles Tenotomy surgical procedure which is required in over 90% of all clubfoot cases. 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.
– if one doctor can't correct clubfoot, another who is skilled in the Ponseti Method will be able to help your child
– finding the right doctor for your child is essential to success.
– many parents have to travel to receive quality care
– traveling isn't cheap
– 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
Treatment of Clubfoot Demonstration.
brace on... because clubfoot really wants to relapse.
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
– * 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's the caregiver.
– 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.
casts.
– plaster is the preferred media for Ponseti casting
– plaster is very moldable and is best suited to correct clubfoot
– fiberglass soft casts are not easily molded and can easily slip.
– plaster casts can also slip if done incorrectly
– casts must be to the groin and bent at the knee at least 90° to help prevent slips
– One slip is a mistake that can be correctetd. while 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
– toes should be flat and fully outside of the cast
– mark on the toes with a pen where the edge of cast is to easily recognize a slip. slipped casts must be removed immediately
– casts can be uncomfortable at first, but should never be painful
Ponseti casts consist of 5-7 casts changed weekly, for most clubfeet
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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