1. Ponseti method for the treatment of congenital clubfoot (CCF)
The tissues of a newborn's foot, including tendons, ligaments, joint capsules, and certain bones, will yield to gentle manipulation and casting of the feet at weekly intervals. By applying this technique to clubfeet within the first few weeks of life, most clubfeet can be successfully corrected without the need for major reconstructive surgery.

2. The Ponseti Technique :
* The Treatment Phase –
Deformity is corrected completely
* The Maintenance Phase –
A brace is utilized to prevent recurrence
# Minimize the possibility of incomplete correction
and recurrences.

3. The Treatment Phase :
The treatment phase should begin as early as possible, optimally within the first week of life.
Gentle manipulation and casting is performed on a weekly basis.
Each cast holds the foot in the corrected position, allowing it to gradually re-shape
Five to six casts are required to fully correct the alignment of the foot and ankle.
At the time of the final cast, the majority of infants (70% or higher) will require a percutaneous surgical procedur to gain adequate lengthening of their Achilles tendon.

4. The Maintenance Phase :
The final cast remains in place for three weeks, after which the infant's foot is placed into a removable orthotic device.
The orthosis is worn 23 hours per day for three months and then during the night-time for several years.
Failure to use the orthosis correctly may result in recurrence of the clubfoot deformity.
Good results have been demonstrated at multiple centers, and long-term results indicate that foot function is comparable with that of normal feet.

8. Management of Recurrence
Ponseti reported a recurrence rate of approximately 50% in his early series, but noted a decrease with greater emphasis placed on the use of the foot orthotic.
Early recurrences are best treated with several long-leg plaster casts applied at two-week intervals. The first cast may require correction of recurrent foot deformity, with subsequent casts to correct ankle tightness.
An Achilles tendon lengthening may be necessary if there is insufficient correction at the ankle, and a tendon transfer (of the tibialis anterior tendon) may be performed in older children to help maintain the correction

9. Conclusion:
The Ponseti technique is gaining widespread acceptance as the treatment of choice for infants with clubfeet.
If a child's physician meticulously follows the details of this technique and applies all of the elements without modification, parents can expect optimal results in the short and long term for children with clubfeet.

10. Further Reference :
Ponseti method for the treatment of congenital clubfoot (CCF)
The Journal of Bone and Joint Surgery
Issue: Volume 98(20), 19 October 2016, p 1706–1712

11. Conclusions:
Ponseti treatment with TATT, which was performed in 88% of the feet, was effective, and satisfactory results were achieved in 84% of the feet.
At the time of follow-up, no patient showed an abnormal gait, all feet were plantigrade and flexible, but 2 feet (2.9%) had relapsed.

12. Q & A
Dr. 熊永萬
Dr. Bear