Ponseti Technique


Further Casting: Manipulation and casting is continued on a weekly basis for the next two to three weeks in order to gradually straighten the forefoot, allowing the forefoot to move in line with the heel. (Figure 5)
The third cast - The Achilles tendon is stretched, bringing the outer edge of the foot into a more normal position.
Figure 5: The third cast. The Achilles tendon is stretched, bringing the outer edge of the foot into a more normal position as the forefoot is turned further outward.
After four or five casts have been applied, normal position of the foot will begin to be observed.
The Achilles tendon: The Achilles tendon is the cord behind the ankle that allows the ankle to move up and down. In children with clubfoot this tendon is shortened, preventing the ankle from bending up properly. In the majority of these children the tendon must be lengthened in order to allow sufficient ankle motion. In the Ponseti technique, this is accomplished with a percutaneous surgical release of the tendon which allows the ankle to be positioned at a right angle with the leg. This percutaneous release is a quick procedure that is typically done through a small puncture, under local anesthesia.

The final cast: The foot and ankle are then casted in the final, corrected, position. (Figure 6)
The final cast - Achilles tendon stretched further with forefeet pointed upward.
Figure 6: The final cast is applied, and the Achilles tendon is stretched further with the forefeet pointed upward. This cast is typically applied in 2 stages, with the short leg component extended up to the groin once the lower component has hardened.
A total of five or six casts are typically needed to correct the foot and ankle. More are rarely needed in the most severe cases of club foot.



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