Ponseti method

The Ponseti method is a manipulative technique that corrects congenital clubfoot without invasive surgery. It was developed by Dr. Ignacio V. Ponseti of the University of Iowa Hospitals and Clinics, USA in the 1950s, and was repopularized in 2000 by Dr. John Herzenberg in the USA and Europe and in Africa by NHS surgeon Steve Mannion. It is a standard for the treatment of club foot.

Ponseti treatment was introduced in UK in the late 1990s and widely popularized around the country by NHS physiotherapist Steve Wildon. The manipulative treatment of clubfoot deformity is based on the inherent properties of the connective tissue, cartilage, and bone, which respond to the proper mechanical stimuli created by the gradual reduction of the deformity. The ligaments, joint capsules, and tendons are stretched under gentle manipulations. A plaster cast is applied after each manipulation to retain the degree of correction and soften the ligaments. The displaced bones are thus gradually brought into the correct alignment with their joint surfaces progressively remodeled yet maintaining congruency. After two months of manipulation and casting the foot appears slightly over-corrected. After a few weeks in splints however, the foot looks normal.

Proper foot manipulations require a thorough understanding of the anatomy and kinematics of the normal foot and of the deviations of the tarsal bones in the clubfoot. Poorly conducted manipulations will further complicate the clubfoot deformity. The non-operative treatment will succeed better if it is started a few days or weeks after birth and if the podiatrist understands the nature of the deformity and possesses manipulative skill and expertise in plaster-cast applications.

Clubfoot (talipes equinovarus) affects almost 150,000 children annually. Almost 80% of these children live in developing nations. Dr Ponseti's technique is painless, fast, cost-effective and successful in almost 100% of all congenital clubfoot cases. The Ponseti method is endorsed and supported by World Health Organization National Institutes of Health, American Academy of Orthopedic Surgeons, Pediatric Orthopedic Society of North America, European Pediatric Orthopedic Society,CURE International, STEPS Charity UK, STEPS Charity South Africa, A Leg to Stand On (India) and others.

At the 2007 International Clubfoot Symposium attended by 200 doctors from 44 countries, papers were presented for an estimated 10,000 children successfully treated with the technique around the world in the past few years.

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