The physicians at Children’s Orthopaedics of Atlanta treat clubfoot in accordance with the Ponseti Method. The Ponseti Method began gaining wide acceptance in the late 1990s. It was developed at the University of Iowa by Dr. Ignacio Ponseti, MD. This method of treatment is minimally invasive and is about 95% effective when done properly by trained healthcare providers like our physicians at COA. The Ponseti Method is now considered the “gold standard” of clubfoot treatment.
As an overview, the Ponseti Method involves a series of specific gentle manipulations and cast applications. The casts go from the toes up to the upper thigh. The sessions are done in weekly intervals. Before the final cast, a heel cord (Achilles) tendon clip is usually required to complete the correction. The heel cord will regenerate within three weeks. After the last cast is removed, a brace consisting of a bar with shoes attached to it is applied to prevent relapse of the deformity. This brace is to be worn twenty-three out of twenty-four hours a day for at least three months (or possibly longer), and then at night and naps until about age four years.
At COA, there are two exceptions to the classic Ponseti Method that are typically made. One is that most COA physicians use a semi-rigid fiberglass material for the casting, instead of the plaster of Paris material used by Dr. Ponseti. We have had similar satisfactory results with this material, and it does not require any cutting to be removed—making the experience easier for the child and the parents. The other exception is that the heel cord clip is performed in the operating room under general anesthesia, as opposed to in the office/clinic under local anesthesia as Dr. Ponseti had done. We feel that this procedure is more safely done in the operating room.