Ponseti Technique

 


After the first cast, the foot is straight and the cavus and crease are no longer evident.
Figure 3: After the first cast, the foot is straight and the cavus and crease are no longer evident.
It is usually easiest to apply the cast in two stages: first a short-leg cast to just below the knee, which is then extended above the knee once the plaster sets. This is preferable in older children (beyond 2 to 3 months) who are stronger and less easily consoled during the casting. Ponseti emphasizes the importance of long-leg casts, which are essential to maintain adequate stretching of tendons and ligaments.

Second Cast: One week later, the first cast is removed and, after a short period of manipulation, the next toe-to-groin plaster cast is applied.(Figure 4)
The second cast is applied with the outer edge of the foot still tilted downward.
Figure 4: The second cast is applied with the outer edge of the foot still tilted downward and the forefoot moved slightly outward.
This phase in the manipulation and casting process is focused on straightening the foot, aligning the forefoot with the heel. Care is taken to maintain the downward tilt of the foot; correction of this downward tilt - due to tightness of the ankle - will occur in subsequent casts. Before casting, the physician manipulates the forefoot according to Ponseti's carefully described technique in order to stretch the foot, determining the amount of correction that can be maintained when the plaster cast is applied.
Another crucial point in the Ponseti technique which is radically different than other techniques, is that the heel is never directly manipulated. The gradual correction of the hindfoot and midfoot are such that the heel will naturally move into a correct position.

 
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