The Ponseti method is a manipulative technique that corrects congenital clubfoot without invasive surgery.
It was developed by Ignacio V. Ponseti of the University of Iowa Hospitals and Clinics, US, in the 1950s, and was repopularized in 2000 by John Herzenberg in the US and Europe and in Africa by NHS surgeon Steve Mannion.
[citation needed] Ponseti treatment was introduced in UK in the late 1990s and widely popularized around the country by NHS physiotherapist Steve Wildon.
A plaster cast is applied after each manipulation to retain the degree of correction and soften the ligaments.
The displaced bones are thus gradually brought into the correct alignment with their joint surfaces progressively remodeled yet maintaining congruency.
The non-operative treatment will succeed better if it is started a few days or weeks after birth and if the podiatrist understands the nature of the deformity and possesses manipulative skill and expertise in plaster-cast applications.
The Ponseti method is endorsed and supported by the World Health Organization,[2][3] National Institutes of Health,[4] American Academy of Orthopedic Surgeons,[5] Pediatric Orthopedic Society of North America,[6] European Pediatric Orthopedic Society,[7] CURE International,[8] STEPS Charity Worldwide,[9] STEPS Charity South Africa,[10] and A Leg to Stand On (India).
The cast is molded to contour around the heel while abducting the forefoot against counter pressure on the lateral aspect of the head of the talus.
This allows for monitoring of the progress of the forefoot abduction and, in the later stages, the amount of dorsiflexion or equinus correction.
The cavus should be separately treated as outlined in step 2, and the equinus should be corrected without causing a midfoot break.
Following the manipulation and casting phase, the feet are fitted with open-toed straight-laced shoes attached to a Denis Browne bar.
In 10–30% of cases, a tibialis anterior tendon transfer to the lateral cuneiform is performed when the child is approximately three years of age.