Clubfoot: The Ponseti Method of Treatment
It is estimated that more than 100,000 babies are born worldwide each year with clubfoot deformity. 80% of these babies are born in developing nations, and most are untreated or poorly treated. Neglected clubfoot causes crushing physical, social, psychological and financial burdens on the patients, their families, and society. Globally, neglected clubfoot is the most serious cause of physical disability amongst all the congenital musculoskeletal disorders.
Clubfoot, also called congenital talipes equinovarus (CTEV), is a congenital deformity involving one or both feet. The affected foot appears rotated internally at the ankle, resembling a golf club. It is a relatively common birth defect, occurring in about one in every 1,000 live births. Approximately half of the children with clubfoot have it in both feet. With proper treatment in early childhood, these children can have normal-looking feet and play outdoor sports like any other child.
Prof. Ignacio Ponseti of Iowa, USA revolutionised the treatment of clubfoot. We at Ananya Orthopaedic Center follow the principles of Ponseti in treating children with clubfoot deformity. Treatment begins as early as 3–4 days after birth. It involves gentle corrective manipulation of the feet, holding the correction in above-knee POP casts. These children do not need any anaesthesia or sedation for this gentle manipulation and cast application, and one of the immediate family members can be present while the procedure is carried out.
Typically, these children need between 4 and 6 corrective cast applications at weekly intervals. At this stage, the majority of children need a small surgical release of the heel cord (Achilles tendon) to complete the correction. This heel-cord release is a day-care procedure done under sedation, followed by the final corrective POP cast, which remains for 3 weeks. This completes the acute correction of the clubfoot deformity.
Parents are an active part of this treatment protocol — equal partners with the treating surgeon in achieving and maintaining a correction that lasts a lifetime. As soon as the last POP cast comes off, the child's feet go into a Foot Abduction Brace (FAB) to maintain the correction achieved by the casts. The brace is a device with two boots attached to a bar, holding the feet in the corrected position. Bracing is round the clock for the first 3 months, and then for 16–20 hours a day, based on the treating surgeon's advice, for the next 3 years. Strict adherence to this bracing protocol is essential for complete and lasting correction.
The commonest cause of recurrence after complete correction is deviation from this strict bracing protocol. Recurrent deformity is more difficult to treat, less likely to result in normal-looking feet, and may in some instances necessitate extensive surgery resulting in unsightly and painful scars.
Ponseti treatment is the most commonly practised method of clubfoot treatment around the world today, and Ananya Orthopaedic Center is committed to offering this world-class treatment at an affordable cost. Please feel free to talk to the Doctor for any more information you may need.