Still Foot and Ankle Care Center, Podiatrist offices in Denver, Arvada, and Golden Colorado - Congenital Clubfoot

Congenital Clubfoot - Ponseti Technique (Pie Talo)

Congenital clubfoot is one of the most common congenital orthopedic deformities. It happens approximately 1 in 1000 live births in the U.S. and 1/250 live births in the developing world. Researchers know there is a genetic component because it can run in families but there may be other factors such as nutrition or intrauterine positioning. It happens to both feet approximately 50% of the time at birth.

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Dr. Still was recently educated on the world renowned treatment developed by Dr. Ignacio Ponseti, an orthopedic surgeon who recently passed on 10/18/09. Dr. Ponseti was known throughout the world as the leading expert in treatment of congenital clubfoot. He was pioneering in his work on a highly successful non-surgical treatment option for infants and children. It has helped hundreds of thousands of children around the world. He developed a treatment at The University of Iowa clinics in 1944 and it has been utilized since. However, his treatment did not become widely accepted outside of the Midwestern U.S. until approximately 10-15 years ago. The orthopedic community previously had been quick to utilize surgery for this deformity. However, with his techniques of manipulation, casting and minor surgery on the Achilles tendon in infants and children it has proven through many studies to be more successful and less traumatic than surgery. In some areas of the country, especially here in Colorado surgery is still promoted as the primary treatment option. However, in many clinics and children’s hospitals in other major U.S. cities it is the standard of care.
At the University of Iowa clinics children come from all over the globe to be treated. However, more and more physicians are being trained in the technique so that they can carry on Dr. Ponseti’s work and mission.

This type of treatment involves manipulation and casting of the infant or child for the first 3-5 weeks of treatment. This is usually done every 5-7 days. At 5-6 weeks a minor office procedure may need to be done to lengthen the Achilles tendon. This is usually done under local anesthetic only while the mother or father holds the child. After that casting is done for a few more weeks then the child is fitted with a special brace that he/she wears for most of the day (23 hours). Over time the brace time is reduced as the child gets older and when the child begins walking it is used at nap time and at night time while sleeping. The child may need to wear the brace at night for the first 4-5 years of life. This treatment has proven through studies to be more effective than surgical treatment. The biggest cause of failure is failure of the parents to follow the strict guidelines on time used for the bracing.

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The manipulation and casting is usually not painful for the child. It is helpful if the parents use a pacifier or bottle or nurse the baby while the doctor and his assistant apply the cast. The cast is applied up to just below the hip. The casts are removed by the parents by soaking them off in a bathtub or basin prior to each visit. This way no cast saws are used at removal to scare the child and parents. For children who are no longer infants bringing a favorite toy is helpful to distract them while the casting is done.

Parents of infants born with clubfeet may be reassured that their baby, if otherwise normal, when treated by hands trained in the “Ponseti technique” will have normal looking feet with normal function for all practical purposes. The well treated clubfoot is no handicap and is fully compatible with a normal, active life. The majority of clubfeet can be corrected in about 6-8 weeks with gentle manipulation and toe to groin plaster casts changed about once a week. After that, as stated above, bracing is vital to the long term success. A recurrence is possible even with proper treatment but greatly increases if parents do not follow the bracing protocol and come in for regular check-ups.

Parents need to be reassured that this method is actually more successful than major surgery and results in a more functional foot with less scarring and less chance of arthritis to the foot when the child becomes an adult. Photos coming soon. Two excellent reference books are Clubfoot: Ponseti Managment, 3rd edition, edited by Lynn Staheli, MD, published by Global Help Books, 2009 and Congenital Clubfoot; Fundamentals of Treatment by Ignacio Ponseit, MD, published by Oxford Medical Publications, 2000. For more information please visit this link to University of Iowa Health Care's Health Topic titled “To Parents of Children born with Clubfeet”.

Arvada Office
303.425.4680
Denver West / Golden
303.233.8295
care@drstill.com

Clinical or medically related questions cannot be answered on this website. Please call one of the offices. If your problem needs immediate attention proceed to the nearest Emergency Room or call 911.