Ponseti Method for Clubfoot in Children

If your baby has been diagnosed with clubfoot—either after a prenatal ultrasound or immediately after birth—our doctors partner with you to begin treatment in the first weeks of your baby’s life. The New York Ponseti Clubfoot Center at the Center for Children, part of Hassenfeld Children’s Hospital at NYU Langone, is staffed by clubfoot specialists who have been trained in the Ponseti method, a minimally invasive treatment approach in which casts and braces are used to gradually correct the position of your baby’s foot or feet.

The Ponseti method was developed by Dr. Ignacio Ponseti in the 1950s and has since become the preferred method of our doctors. When treatment begins within the first three weeks after birth, most infants grow up without any physical symptoms, pain, or walking dysfunction due to clubfoot. This treatment has a success rate of greater than 90 percent, and results can be seen after one or two weeks of casting.

Weekly Casting

During the first several weeks of treatment, our specialists see your infant every week. In these sessions, our doctors gently use their hands to manipulate your baby’s feet, stretching the ligaments and tendons to gradually correct their position and shape. Tendons and ligaments are very flexible in newborns, and this process causes your child no pain.

After your baby’s foot has been stretched and positioned, doctors apply a plaster cast from toe to thigh to reinforce the foot’s corrected shape and position. Each week, the cast is removed. Our doctors then stretch and reposition your child’s feet again, and another cast is applied. This process continues for four to eight weeks, depending on the tightness of your baby’s ligaments and tendons—tendons that are less flexible may require six to eight weeks or more of casting before they are fully repositioned. After doctors have fully corrected the position of your baby’s foot or feet, a final cast is applied. This final cast is worn for three weeks.

Percutaneous Achilles Tenotomy

Before the final cast is applied, approximately 80 percent of infants require an additional procedure called percutaneous Achilles tenotomy to ensure that the foot grows normally. Unlike most of the tendons in a baby’s foot, the Achilles is made of thick, inflexible fibers and sometimes needs to be cut to allow for a thorough repositioning of the foot.

This procedure occurs in the doctor’s office and takes just a few minutes to perform. Your child’s doctor applies a local anesthetic to the foot, so your baby feels no pain. The doctor then uses a needle to make a small puncture in the back of the foot, cutting the Achilles tendon. No stitches are required. The final cast is then applied. Most children experience little if any discomfort after the procedure. Our doctors recommend acetaminophen if your child seems to be uncomfortable.

During the three weeks that your child wears the cast, the Achilles tendon regrows to a longer length, due to the positioning of the cast. When the cast is removed, the tendon has healed and allows for greater range of motion, allowing your child’s foot to be correctly positioned.

Dynamic Foot Braces

In the next phase of the Ponseti method, doctors use a specialized foot brace to continue corrective therapy. The recommended brace is a device that attaches a pair of open-toed shoes to the top of a lightweight bar, keeping your baby’s feet a fixed distance apart. This bar is the width of your baby’s shoulders, and the shoes are pointed slightly outward to provide a gentle stretch. At Hassenfeld Children's Hospital, an orthotics specialist creates a custom-fit brace for your infant.

During this bracing phase, you play a vital role in your baby’s treatment. Every day for three months, you need to put this brace on your baby’s feet and keep it on for 22 to 23 hours per day. The brace may be removed for baths and meals.

Your child’s doctors typically ask that you bring your child to their offices for follow-up appointments occurring two weeks, six weeks, and three months after bracing has begun. These allow our doctors to monitor your baby’s progress and make sure there are no complications. Occasionally, a baby may develop blisters from wearing the brace. If this occurs, our orthotics specialists make adjustments to the brace to improve the fit.

After three months, your baby can wear regular shoes or socks during the day but must wear the brace at night. This continues for two to four years. Your child’s doctors, who schedule follow-up appointments every three to four months to monitor the effectiveness of treatment, determine the exact duration of nighttime bracing.

Clubfoot Relapse

Working in partnership with parents, our doctors have successfully treated hundreds of babies using the Ponseti method. You can help your infant completely recover from clubfoot by making sure braces are applied for the full amount of time prescribed.

However, in a small percentage of children, clubfoot can relapse. Reasons for a relapse vary, but the most common cause is that the braces were not worn as long as necessary.

If clubfoot returns, doctors often start the Ponseti method again. The entire series of casts is repeated until your baby’s foot is again corrected, and the percutaneous Achilles tenotomy is also repeated. Then the brace needs to be worn exactly as the doctor prescribes, in order to ensure successful and permanent repositioning of the foot.

Therapy for Older Children

Most clubfoot diagnoses are made during a prenatal ultrasound exam or immediately after a baby is born, with treatment using the Ponseti method beginning in the first three weeks of the infant’s life. However, in some circumstances, treatment may be delayed. Children who did not have access to healthcare as infants, for instance, may not have received treatment.

In addition, certain neuromuscular conditions, such as arthrogryposis, spina bifida, or others, affect muscle tone and may cause clubfoot to develop during early childhood. If your child was not treated for clubfoot during early childhood, your child’s feet may need to be corrected later in life to improve mobility or relieve pain caused by progressive abnormalities in the bones and tendons of the foot.

Our doctors recommend the Ponseti method as an effective form of treatment for any child with clubfoot, even if your child is older and has never been treated for clubfoot. Doctors apply weekly casts, followed by a percutaneous Achilles tenotomy, followed by a period of bracing. Because the ligaments and tendons of an older child are less malleable than those of infants, treatment may take longer.

Our specialists determine the exact number of casts required, and after casting is complete, our doctors partner with you to ensure that the right type of brace is used for an adequate length of time.