The Ponseti Method of correcting clubfoot involves 5-7 weekly thigh high plaster casts bent at the knee 90 degrees or more. The last cast is usually after a minor surgical procedure called the Percutaneous Achilles Tenotomy (PAL) that stays on for 3 weeks after the procedure. This cast can sometimes become too small and need to be replaced midway through the 3 weeks, but this is rare. For most babies, this cast stays on the full 3 weeks. After the last cast is removed, the baby wears the Foot Abduction Bar (FAB) or "Boots & Bar" (BnB) for 4-6 years. Please see our Bracing pages for more information about the FAB/BnB and all things bracing.
We are working on Dr. reviews as associated of our pages of non-recommended doctors, but right now the Red Light/Green Light List is the best we can provide.
Clubfoot treatment over 4-6 weeks
Plaster Ponseti Casts - Shows knee bend and abduction
The Stages of Clubfoot Correction
Clubfoot casting is not something every Orthopedic Surgeon knows how to do. It is not a surgery, and that is often not worth their time. Beware of any Orthopaedic Surgeon who makes you feel like they are not interested in treating clubfoot without surgery (disinterested in casting, others do the casting, insisting slipped casts are the baby's fault, etc.)
Some parents never see the surgeon who does their baby's tenotomy. Many surgeons aren't actually interested in doing clubfoot treatment. If your surgeon leaves casting to others in their practice, this is a Red Flag.
It is the way the trade works that most surgeons prefer to do surgery, and tenotomy is the only part that they do. When the surgeon is absent most of the time, it is a sign that the physician is not very interested in the child's treatment. This is a red flag that should not be ignored.
Some are interested in non-surgical treatments and participate, but the surgeon is made to be the kind of person who excels at cutting. This is not to disparage surgeons, we absolutely need people like this to fix things that need surgical intervention. Not every doctor is able to perform surgery, and we love them when we need them.
We also love any surgeon who is dedicated to the Ponseti Method and who is an active participant in the clubfoot correction process.
Clubfoot has historically been treated with surgery (once surgical methods were developed - (see Treatment of idiopathic clubfoot: an historical review. - Dobbs MB, Morcuende JA, Gurnett CA, Ponseti IV. Iowa Orthop J. 2000;20:59-64). It is only recently that correction without surgery using the Ponseti Method became mainstream. It is not something that just any doctor knows how to do. They must be trained specifically in the Ponseti Method, which is not just "wrenching the foot into position".
Failure Rates
The failure rate of Ponseti Method is associated with the feet that require surgery down the line, after all casting and bracing efforts have been exhausted.
Dr. Ponseti repeatedly proved that if the method and bracing protocols are followed, the failure rate is approximately 3%. Other caregivers often modify the method, in either ways of casting or surgical modifications, or by way of bracing modifications. These changes nullify results obtained after modified methods.
Relapsing
Some feet will relapse no matter what you do, even with strict bracing (about 3%, if you look at Dr. Ponseti's data, significantly higher if you look at most the rest of the data from others who have no consistent protocols). However this kind of relapse is treated with a much more minor surgery than has been typical. This is usually the the Anterior Tibialis Tendon Transfer. It often fully resolves any reoccurring pulling of the tendons that is unable to be overcome with casting and bracing by transferring the tendon to a different location in the foot. This surgery is usually only done after the age of 4, or older. After growth spurts are finished and all casting and bracing options have been exhausted, and the foot has been fully corrected otherwise (The function of the tendon transfer is not to provide correction; rather, it is to maintain correction that has been previously obtained). If your doctor wants to do this surgery earlier than the age of 4-6, a second opinion might be an option just to be sure of this course of treatment.
We do not have data on relapse that is either a) consistent across all papers in ANY way, nor do we have good consistent data on relapse that is b) specifically studied in association with bracing protocols. Our Studies Page has links to as many papers on clubfoot that we can find, and none of it consistently describes relapse and bracing protocols in over 650 papers, and none of it (with one exception) really compares Dr. Ponseti's Method to all the different modifications of the Method.
Some feet will relapse despite full compliance with bracing. We believe this to be a lower rate than is normally reported in papers. Due to the inconsistencies as associated with clubfoot treatment. This not only affects the rates of study results, it is a significant issue with clubfeet across the globe.
Some doctors are still unable to correct clubfoot like other doctors are able to, and some doctors still don't believe the method works better than surgery. When a clubfoot is deemed "not able to be corrected without surgery", it is not the fault of the child, the foot, or the parent. Any doctor that is unable to get a proper correction of a clubfoot with casting alone (and Achilles Tenotomy) is suspect, and this is the perfect reason to get a second opinion.
Your doctor may or may not be trained to properly correct clubfoot without surgery. Many doctors now are doing non-surgical corrections without the proper training. Many deviate from the Ponseti Method in the form of changing the casting material, or the process of manipulating the foot/bones into position, or by changing the bracing protocols and bracing schedules. All of these changes are considered modifications of the method, and are usually a significant part of any failed clubfoot correction.
There actually are no feet that can't be corrected with the Ponseti Method that I have ever heard of. I have heard of plenty of Dr's who can't correct some clubfeet, but none that couldn't be corrected by someone (else). Some feet will relapse, but nearly every foot can be corrected and braced if the practitioner is skilled in the Ponseti Method.
When the Ponseti Method is followed to a "T", the same results as Dr. Ponseti are achievable. When Dr's are unable to achieve Dr Ponseti's success rates, this only reflects on the Dr's skill level. It does not reflect on the Ponseti Method.
This documentary video was released in June 2021. Delightfully done, it shows the casting process and manipulation prior to wrapping under the outside layers. Plaster casting does not equate to fiberglass.
The Ponseti Method is really all about plaster casts. Drs keep trying to make it work with the "soft casts" that aren't as messy, but then they fail and slip and cause complex clubfoot over and over and over. So no, we don't accept fiberglass casts. Even if they do work sometimes, sometimes the Posterior Medial Release also worked. Or any of the other surgeries that "worked".
Blobby fiberglass casts do not do the same as specifically molded plaster casts. NoSurgery4Clubfoot does not endorse or recommend fiberglass casts.
