Introduction: A Brief History of the Ponseti Method

Ignacio V. Ponseti can be credited with developing a comprehensive technique for treating congenital clubfoot in the 1940s. One of the major principles of this technique is the concept that the tissues of a newborn's foot, including tendons, ligaments, joint capsules, and certain bones, will yield to gentle manipulation and casting of the feet at weekly intervals. By applying this technique to clubfeet within the first few weeks of life, most clubfeet can be successfully corrected without the need for major reconstructive surgery.
This technique is based upon Ponseti's experiences with the wide variety of treatments being applied at that time and his observations in the clinic and operating room, as well as his anatomic dissections and analysis by using a movie camera to produce radiographic images. Utilizing these principles and his understanding of clubfoot anatomy, Dr. Ponseti began employing this technique in 1948 at the University of Iowa. Recently, his observations have been confirmed using modern techniques, including Magnetic Resonance Imaging (MRI).
The Ponseti technique has become the most widely practiced method for initial treatment of infants born with clubfeet. It is an easy technique to learn and, when applied accurately, it yields excellent results.

The Ponseti Technique
The corrective process utilizing the Ponseti technique can be divided into two phases:

• the treatment phase, during which time the deformity is corrected completely, and
• the maintenance phase, during which time a brace is utilized to prevent recurrence.

During each of these phases, attention to the details of the technique is essential to minimize the possibility of incomplete correction and recurrences.

• The Treatment Phase

The treatment phase should begin as early as possible, optimally within the first week of life. Gentle manipulation and casting is performed on a weekly basis. Each cast holds the foot in the corrected position, allowing it to gradually re-shape. Generally 5 to 6 casts are required to fully correct the alignment of the foot and ankle. At the time of the final cast, the majority of infants (70% or higher) will require a percutaneous surgical procedure (with a small incision through the skin) to gain adequate lengthening of their Achilles tendon.