We can help you find a Dr. who can help your child's foot/feet.
What does NoSurgery mean? Are you anti-surgery, against all surgery?.
Why the Name "NoSurgery4Clubfoot"?
NoSurgery4Clubfoot is not opposed to every surgical procedure used in the treatment of clubfoot. The name dates back to a time when major reconstructive surgery was considered the standard treatment for most children born with clubfoot, before the Ponseti Method became widely accepted as the standard of care.
The first online parent support community for clubfoot was the Yahoo! Groups mailing list **NoSurgery4Clubfoot**. That community became one of the earliest online advocates for the Ponseti Method, helping parents find experienced Ponseti providers and avoid the major reconstructive surgeries that had become routine for generations of children.
The importance of this community was recognized in one of the first published studies examining the role of online parent support in clubfoot treatment, *The Effect of the Internet in the Treatment of Congenital Idiopathic Clubfoot*.
Many of the parents who encouraged Dr. Ignacio Ponseti to come out of retirement to teach and treat children were members of this community. They helped spread accurate information about the Ponseti Method at a time when it was still largely unknown outside of Iowa. Like many other families, my own daughter benefited from their knowledge and guidance, and without that support her life today would likely have been very different.
Before the Ponseti Method became the standard of care, many children were treated with months of unsuccessful casting followed by major reconstructive surgery, often before their first birthday. These procedures frequently involved extensive soft-tissue releases, cutting or reshaping bones, tendon transfers, or joint fusion procedures. Children treated surgically often underwent repeated operations throughout infancy and childhood in an attempt to maintain correction, with many requiring additional revision, reconstructive, or salvage procedures into adolescence and adulthood.
Dr. Ponseti recognized that while these operations could make a foot appear straighter, they often sacrificed the very qualities that make a foot function well. His method was designed to correct the deformity while preserving the foot's strength, flexibility, and long-term function. For many people who underwent reconstructive surgery, the long-term consequences have included chronic pain, stiffness, weakness, arthritis, reduced mobility, disability, and additional surgeries throughout life. Those effects are still experienced by thousands of children, teenagers, and adults today.
When we refer to "surgery" throughout this website, we are referring to these major reconstructive procedures—not the minor **Percutaneous Achilles Tenotomy**, which is an essential part of the original Ponseti Method and is required in more than 90% of children with clubfoot. Although it is a surgical procedure, it is fundamentally different from the reconstructive operations that gave this website its name. The Achilles Tenotomy is typically performed in the office using a local anesthetic and is intended to complete the correction achieved through Ponseti casting.
Likewise, this dos not refer to the **Anterior Tibialis Tendon Transfer (ATTT)** used for selected recurrent clubfeet after Ponseti treatment. When performed according to Ponseti principles, an ATTT should be considered only after appropriate casting and bracing have been exhausted and is generally not recommended in younger children before approximately 4 years of age, with many experienced Ponseti clinicians preferring to delay it until the child is older.
The mission of NoSurgery4Clubfoot has always been the same: to help families find experienced Ponseti providers, understand the original Ponseti Method, and ensure that every reasonable conservative treatment option has been exhausted before a child undergoes major reconstructive surgery. Once that surgery is performed, it cannot be undone.
In this context, "surgery" refers to the major reconstructive procedures historically performed to treat clubfoot, such as the PosterioMedial Release (PMR) surgery shown to the left (above on mobile). These surgeries were commonly performed between 9 months and 12 months of age and often marked the end of conservative treatment options. Once extensive reconstructive surgery has been performed, it is generally no longer possible to return to treatment using the original Ponseti Method in the same way as an untreated foot.
Some published research suggests that previously operated feet may still benefit from Ponseti casting in selected cases. However, extensive reconstructive surgery often leaves the foot permanently stiffer and less flexible, making treatment more challenging and reducing the potential to achieve the same outcomes as a foot that has never undergone surgery. This is one of the reasons the Ponseti Method is now recognized worldwide as the gold standard for treating idiopathic clubfoot.
The original NoSurgery4Clubfoot Yahoo! Group was created during a time when major reconstructive surgery was still routine for many children with clubfoot. The group advocated for the Ponseti Method long before it became widely accepted. During the late 1990s and early 2000s, relatively few children were treated using the Ponseti Method, and many surgeons remained unconvinced despite the growing body of published research demonstrating its success.
NoSurgery4Clubfoot is not about avoiding every surgical procedure. It is about preserving the original Ponseti Method without unnecessary modifications, exhausting every reasonable conservative treatment option, and avoiding major reconstructive surgery whenever possible.
Some clubfeet will relapse, even when everything has been done correctly. Our goal is to provide parents with the best information available so that as many children as possible can achieve a functional, pain-free foot without major reconstructive surgery. Dr. Ponseti repeatedly demonstrated through decades of clinical practice and published research that this goal is achievable for the overwhelming majority of children.
If surgery is ever recommended, make sure every reasonable Ponseti Method option has first been exhausted. Seek second and even third opinions from independent physicians with extensive experience using the original Ponseti Method—not simply from other surgeons within the same practice or hospital system. Major reconstructive surgery permanently changes the foot and cannot be undone.
For a relapsed clubfoot, additional Ponseti casting should almost always be considered before surgery. A relapsed foot should first be corrected back to a supple, fully corrected position before anAnterior Tibialis Tendon Transfer (ATTT)is considered. An ATTT is intended tomaintaina corrected foot—it is not designed tocorrecta foot that remains curved or incompletely corrected. When performed on an uncorrected foot, the procedure is far less likely to achieve its intended result.
An ATTT is also not an operation that should be rushed. It is generally reserved for children who are old enough for the procedure to be performed appropriately after all reasonable casting and bracing options have been exhausted. In experienced Ponseti practices, surgery is used to support successful conservative treatment—not to replace it.
Major reconstructive procedures, including extensive soft-tissue releases, should be considered only after every appropriate conservative option has been explored with experienced Ponseti specialists.
Questions to Ask Before Consenting to Surgery.
– Has my child's foot been returned to a fully corrected position with Ponseti casting?
– If not, why not?
– What additional casting options remain?
– Why is surgery recommended now rather than after further casting?
– Would you recommend the same treatment if this were your own child?
– Have I received an opinion from an independent Ponseti specialist outside this practice?
– What published Ponseti research supports this recommendation?
Where did NoSurgery come from?.
NoSurgery4Clubfoot was a Yahoo Group that I (Kori Rush - Mom of Darbi) discovered online in 2003 when my daughter was born with right clubfoot (RCF).
This kid, my third unplanned caesarean section... and even though I had a laptop at the hospital and could get online, all I wanted to do was sleep.
I'd worked through the other two kid's hospital stays, and I didn't even open it up to do the research this time. I just wanted to sleep and I didn't care that my child's foot was bent, I was gonna figure it out later. Also the doctors didn't say it was an emergency.
I wasn't aware before she was born and they were sending the attending down to see her, she was gonna be fine. My mom worked for the Pediatrics clinic at the local Medical University at the time and all my kids were able to see the Attending at her clinic. I really was not concerned.
She was casted by the Ortho Specialty docs on the day we went home. And I only then did I take the time to look things up. I found the Yahoo group immediately. And after a short time discovered that my daughter's cast was incorrect (fiberglass), and also that there was a Ponseti Dr. here at our local Shriners Hospital. Which is actually across the street from the University Hospital we were already being seen, so it was an easy choice to go to them instead and get Ponseti Method. She was given 4 plaster casts, and everything was going along swimmingly!
Hole that finally showed heel rising up, shoe wasn't on properly and also not tight enough
Healed sore, after 1 week healing cast
Finally, no more sores, no more tears! Side sleeping with pillow propping up knees.
After we got into the Foot Abduction Bar (BnB) my little girl got a sore on her heel from a blister. They (the doctor, the orthotist shop, no one) couldn't help us, with all the padding and everything we tried there was no solution (see images to the left, or above for mobile). Still she had a huge quarter sized awful sore. I knew she had to wear the brace, so we worked through the crying but eventually she got a healing cast for a week.
That healed the sore, but then it came right back. I asked them to cut a hole in the back of her shoe... then suddenly I could see what was happening! She was slipping up in her shoe. And then it dawned on me that it was friction that caused the blisters and I had to figure out how not to allow her foot to move in the shoe. Talk about feeling like an idiot! I was the cause of all my baby's pain and tears!
I was able to figure out how to get her foot into the shoe and make it tight enough so that I couldn't see movement, and all of a sudden all the problems went away. What a wonderful thing it was, and so simple. Preventing friction prevented the blisters that became sores! Duh!
I passed that information onto other parents online for a few years while bracing, (see the original Tips & Tricks PDF) and our group NoSurgery4Clubfoot found new members as we all became great friends online. Our Yahoo group was helping other parents with the ins and outs of bracing and casting, and finding doctors and sources for travel and everything else related to clubfoot.
Today my adult daughter has great and mostly pain free feet, and no one could ever tell she had clubfoot. When her feet hurt after a long day, her FEET hurt just like everyone else's. Both feet equally sore. She only has one clubfoot.
We struggled with many parents coming to the group and saying their doctor said they needed surgery, and would not do the Ponseti Method. These parents were often told their kid's feet were too "severe" or that the Ponseti Method didn't work, or wouldn't work for their child. Most of these doctors couldn't have corrected a clubfoot non-surgically if they tried. Doctors simply had always done surgery and that was how they approached it for every foot.
It was a different time than now, and fortunately it appears most of these surgeons are either practicing the Ponseti Method now, do not treat clubfoot, or have retired. There still are surgeons who do surgery though, and many who are not properly trained (and don't care to become trained), and these physicians often will fail at casting and then tell the parent their child needs surgery.
What happened to the NoSurgery Yahoo Group?.
Yahoo Groups officially shut down entirely December of 2020. There are new support groups on Facebook and other sources of information, because unlike back then... the Ponseti Method is the gold standard of treatment for clubfoot, finally. There are quite a few topic specific groups on Facebook and we encourage you to join any group that you like. For a comprehensive listing of all support groups, see our Online Support Groups page. There are not many local physical support groups but when we find them we will also list them on this website
Moving to the Ponseti/Mitchell Brace.
In 2005 we were fortunate enough to get a donated set of Ponseti/Mitchell Boots and Bar. Which promptly made sores on my kid's heels. So we cut out the back end and talked to John Mitchell about big kid feet and heels which are nothing like infant heels that need a deep heel pocket. John sent us some casting material and foot impressions and we sent back some molds for him to help design the big kid shoes.
Those cut out shoes lasted her till she was 4 years old when we stopped bracing. I know we should have done another year to get the best results, but I knew what to watch for and she was doing very well.
So that's what happened, and then she grew up and hardly even remembers being in her brace, but what she does remember is comfortable and happy. When she looks at other braces she asks, "Why would you want that? It is not doing anything." What else can I do with that? We are happy for the Ponseti Method and want everyone else to have the best chance at good feet forever!
We love the progression of the Ponseti Brace/Mitchell Shoes since then and hope to help everyone who is doing clubfoot bracing with a shoe and bar design. We also support tips and tricks for other braces worldwide and would love some images and tips and tricks for all the other shoes/boots and bars out there. Please contact us for a spot on this website for links and information about your shoes!
See Darbi thank John Mitchell for her new shoes. Sorry for the 30 second videos, that's what I could record back in 2005.
