Ponseti Method: A Giant Step in Non-Surgical Treatment of Clubfoot

Clubfoot KidNine-year-old Ted wasn’t even born when his parents, Bruce and Betsy, began making treatment plans for his left foot.

In 2005, when his mother was pregnant with twin boys, she learned during a prenatal visit that Ted had clubfoot, a condition in which at least one foot is twisted inward and down in an abnormal position.

“I went for an ultrasound and the tech looked at the screen and said, “This one has clubfoot – and this one doesn’t,” Betsy said. “Our first call was to the pediatrician, who referred us to Dr. Jeffrey Thomson.”

Dr. Thomson, an orthopaedic surgeon and director of the Division of Orthopedics, is one of two physicians at Connecticut Children’s Medical Center certified by the late Dr. Ignacio Ponseti to use the Ponseti Method, a protocol designed to treat clubfoot deformity in early infancy. The Ponseti Method is a non-surgical technique that uses gentle manipulation of the foot and plaster casting in babies to achieve correction of the foot.

“We got in touch with Dr. Thomson and made an appointment while I was still pregnant,” Betsy said. “We met with him a few days after Ted and Charlie were born.”

Clubfoot in Newborns
Each year, about one in 800 newborns are born with clubfoot, a condition that occurs more frequently in males than females and often in both feet. While its cause is unknown, genetics are thought to play a role. Left untreated, a clubfoot will remain twisted and may cause problems with walking – and other issues – as the child grows.

Although the Ponseti Method was developed by Dr. Ponseti more than 40 years ago, it has caught on in more recent years as a standard treatment of clubfoot in babies. As many as 30 patients are treated with the Ponseti Method at Connecticut Children’s each year. According to Dr. Thomson, the ideal age to begin treatment is within the first month of life.

“I have treated over 100 patients and, by the far, the Ponseti Method is the best,” Dr. Thomson said. “Ted’s treatment was so successful because his parents were very compliant and did everything that was asked of them.”

Treatment Steps
Initial treatment with the Ponseti Method consists of gentle manipulation of the foot to obtain the best alignment possible. It is followed by a long-leg cast (thigh to toes) to maintain correction. Ted underwent weekly casting for approximately six months, but typically, four to eight weeks of casting is required.

The second step involves a minor surgical procedure called a heel-cord tenotomy in which a tendon is cut to lengthen a muscle that has developed improperly.

The third step uses a Denis-Brown Bar to maintain correction. In this stage of treatment, the child wears special shoes connected to a bar full time until the age of six months and then during the night until the age of two. It is considered one of the most challenging but critical steps of the protocol.

For the Simons, swapping the shoes on the Denis-Brown Bar with special sandals was an important next step, as the shoes proved to be uncomfortable for Ted and had caused his feet to blister. The sandals made all the difference.

“He wore this bar at night until he was five,” Bruce said. “Wearing it was just part of his normal routine.”

Treatment Success

With the Ponseti Method, manipulation and casting is successful in approximately 75 to 80 percent of patients. For the Simons family, following the protocol closely and consistently helped ensure their son’s success. Entrusting his care to Connecticut Children’s was a big part of that equation.ted-blog_soccer-photo

“Dr. Thomson was great about spending time with us,” Betsy said. “He and the rest of the staff were always available for all of our questions.”

For Ted, who will be a fourth grader this fall, being treated for clubfoot is not something or his parents usually think about or discuss. But his successful treatment has allowed him to participate fully in the sports he loves, including tennis, skiing, swimming and soccer. “If you saw him playing tennis, skiing or walking today, you’d never know he had clubfoot as a baby,” Bruce said.

“I’m glad I’m able to participate in so many different sports,” Ted said, “and I’m glad that Dr. Thomson helped make that possible.”

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