Ponseti Method: Purpose, Procedure, Benefits and Side Effects

The Ponseti method is a technique primarily used to correct foot deformities, such as clubfoot, in children. Developed by Spanish-born American orthopaedic surgeon Dr. Ignacio V. Ponseti in the 1940s, it consists of a series of gradual manipulations and casts that are designed to gradually move the foot and ankle bones into their correct positions over the course of several weeks and months.

• Stretching: Stretching exercises are used to relax the contracted calf muscles and gently stretch the Achilles tendon. The patient may also be prescribed night splints, which hold the foot in a corrected position throughout the night while sleeping.
• Manipulation: With the foot held in a corrected position, gentle pressure is applied on specific areas of the foot in order to manipulate it back into its normal position. An X-ray may be taken afterwards to ensure that the bones have been realigned correctly.
• Plaster Casting: A series of plaster casts are then applied to maintain correction for about three weeks before being removed for brief periods for daily checkups, assessments and stretching exercises. Dynamic or functional casts usually replace these static ones as treatment progresses and movement increases in order to further facilitate correction and alignment through controlled forces over time .
• Bracing: Once correction has been achieved it needs to be maintained with a special shoe brace/corrective device worn 23 hours per day for up to 3 years depending on age. This promotes gradual stretching of tight tendons and muscle structures as bone growth occurs so that success can be long lasting.

• Non-Invasive Treatment: The Ponseti Method is a non-surgical procedure with minimal risk or side effects. It consists of stretching exercises and serial casting that are used to gradually manipulate the foot into the correct position.
• Proven Results: The Ponseti Method has been proven to provide long lasting results with success rates as high as 95%, making it the preferred treatment choice for most paediatric orthopaedic surgeons.
• Cost Effective: This technique costs very little in comparison to surgical treatments which can cost much more with higher risk of complications or failure rate.
• Improved Mobility: Active infants treated by the Ponseti Method will typically achieve near normal function, range of motion, and mobility after correctly completing the treatment period.

The Ponseti method is primarily used to treat clubfoot, a condition that causes the feet to turn inward when the person is standing or walking. The method also has applications for other foot conditions such as Larsen's syndrome and congenital vertical talus (a vertical displacement of the talus bone).

Possible development of calcaneovalgus or equinovarus deformity.

• Avascular Necrosis: If the casts are left on too long, there is a risk of the tissues in the foot dying due to lack of circulation.
• Damage to nerves: When manipulating and stretching the tendons, there is a risk that nearby nerves might get damaged during this process.
• Recurrence of deformity: Even after being successfully treated with the Ponseti method, some children may experience recurrence of deformity requiring more treatment or surgery in adulthood.

• Prepare all necessary medical documents, such as birth certificates, insurance information and any other relevant medical records.
• Pack a diaper bag with diapers, wipes and a shirt for the baby that can be changed often.
• Wear loose-fitting clothes and comfortable shoes to allow for easy movement in the hospital setting.
• Arrange transportation or childcare for other children in the family if needed.
• Pack snacks and drinks in case of a long wait at the facility or during care afterwards.
• Bring along any photos of previous casts or corrective shoes that have been used before arriving at the hospital, if available.

The Ponseti Method involves gently manipulating the feet, tendons and muscles to gradually move them toward a better position. This manipulation can be done by the patient’s doctor or physical therapist as often throughout the week.

The achilles tendon may also need to be released in order to release tension in the calf muscles and further help with the mobilisation of the clubfoot. Finally, custom splints may need to be worn until full correction is achieved which can take up to two months or more.

• Consent should be obtained from the parents of the patient.
• The patient should be examined for any underlying medical conditions, if any.
• Appropriate shoes and orthoses are placed on the patient's feet before starting the manipulation.

• The feet should be manipulated to achieve a normal mechanical axis, stretching of soft tissues and positioning of bones into their respective anatomical positions.
• A posterior fibular wedge should be applied for additional stability as directed by a specialist.

• An appropriate cast should be applied to maintain alignment of joints and bones and to help with consolidation of correction.
• The position of the foot and ankle should be checked after cast application to ensure that they stay in an optimal position while in the cast.
• Regular follow up visits need to be scheduled to check effectiveness of the treatment, casting and braces changes if required.

The exact cost of the Ponseti Method in India depends on a number of factors, including the type of clinic, location, and region. Generally, the total cost can range from Rs. 15,000 to Rs. 50,000 or more, depending on the complexity of the patient’s case and other associated costs.

• The best food to eat after undergoing the Ponseti Method for clubfoot treatment is light, nutritious meals that are a balance of complex carbohydrates, proteins, and healthy fats.
• These could include grilled chicken and steamed vegetables, brown rice and roasted salmon, yoghurt with fresh fruit and nuts, hummus and whole-wheat crackers, or a spinach salad with black beans and avocado.
• Avoiding greasy takeaway foods or heavy takeout dishes will help you recover quickly.
• It's also important to stay hydrated by drinking plenty of water throughout the day.

The Ponseti Method is considered a safe and effective treatment option for clubfoot in infants. It involves the use of gentle, nonsurgical manipulations and casting of the feet to gradually shape them into a more normal position. Clinical trials have shown that the technique has a very high success rate and minimal risk of complications.

No, the Ponseti Method is not painful. The Ponseti Method involves manipulating and stretching the foot to achieve a desired result. While it can be uncomfortable at times, it is generally not painful. Parents who have used this treatment report their children don’t seem to mind the procedure.

The recovery time for the Ponseti Method varies widely from patient to patient, depending on the severity and complexity of the condition. Generally, full recovery can take up to one year or more.

The Ponseti Method typically involves a series of weekly manipulations of the foot in order to correct clubfoot. After 6-10 weeks of treatment and casting, it is recommended that patients begin wearing a corrective shoe for up to two years in order to fix the deformity and prevent relapse.

• Common side effects of the Ponseti Method include swelling, redness, pain or discomfort at the site of cast application, as well as blisters and skin ulcers due to prolonged periods in casts.
• It is also possible for over-correction to occur, which may require additional procedures to correct.
• Rarely, nerve injury may occur during manipulation of the foot .

• Ensure the patient wears corrective orthopaedic shoes and the Achilles tendon is everted all times, even during sleep.
• Change the cast application every 4-6 weeks until correction is complete (usually 6-7 casts).
• Orthopaedic shoes must remain in place for at least 12 months after correction to prevent relapse, then a night splint only for another 12 months may be applied.
• Allow physical therapy directed toward daily stretching of calf muscles to help maintain or improve range of motion and functional mobility; this should begin once the foot is corrected with casts.
• Follow-up visits are vital to assess progress and ensure adequate healing; these visits are typically on a monthly basis after correction has been completed until 2 years of age; then twice yearly until 5 years of age; then annually thereafter.

The Ponseti Method is a successful, preferred and evidence-based technique for the treatment of clubfoot. It has been used successfully by many healthcare professionals over the years, however it is important to note that it is not a completely foolproof method and may require patience and consistent monitoring to ensure the best results.