• The Maintenance Phase

The final cast remains in place for three weeks, after which the infant's foot is placed into a removable orthotic device. The orthosis is worn 23 hours per day for three months and then during the night-time for several years. Failure to use the orthosis correctly may result in recurrence of the clubfoot deformity. Good results have been demonstrated at multiple centers, and long-term results indicate that foot function is comparable with that of normal feet.

Manipulation and Casting - Distinct Elements of the Ponseti Method
The unique manipulation and casting maneuvers used in the Ponseti technique are just two examples of several elements which make it quite distinct from other casting methods.

First Cast: Prior to casting, the position of the forefoot (front of the foot) in relation to the heel creates cavus (abnormally high arch) of the foot. The first cast application addresses the foot deformity, aligning the forefoot with the hindfoot (back of the foot). In doing so, the cavus (Figure 1) is corrected (Figure 2), typically after one cast. (Figure 3)

Figure 1: Before treatment. The marked curvature of the foot, called a cavus deformity, is characterized by a visible crease in the midsection of the foot. The foot is tilted down due to tightness of the Achilles tendon.

Figure 2: The initial Ponseti cast. Note the positioning of the forefoot to align with the heel, with the outer edge of the foot tilted even further downward due to Achilles tendon tightness.