Treatment of clubfoot in Ponseti

To describe the characteristic deformation of the foot, when the foot is turned inward from the longitudinal axis of the shin, the term "club foot" is used.

Congenital clubfoot refers to a group of developmental limbs and is a combination of various foot deformities, usually accompanied by foot supination and abnormal musculature of the lower leg. The clubfoot of two stops occurs in about 50 percent of cases. The medical term for general or "classical" clubfoot form is Talipes equinovarus. As a rule, congenital pathology occurs in boys more often than in girls (ratio 2: 1). The causes of the disease are not fully understood.

Along with a congenital defect, there is also an acquired form, the so-called neurogenic clubfoot, caused in most cases by a violation of innervation.

The doctor puts the diagnosis of typical foot defects right after the birth of the child. The clubfoot will not bother the child until he learns to stand and walk. However, clubfoot treatment is prescribed as soon as possible after birth, in order to take advantage of the elasticity of the tissues that form the articular bags, ligaments and tendons, and continues consistently. This is very important in order to achieve optimal results, since the untreated foot will remain twisted, which affects the whole movement of the leg, leads subsequently to arthritic pain.

Children, as a rule, try to treat without surgery, a conservative method known as treatment of clubfoot in Ponseti (therapeutic massage and plaster bandages).

Most clubfoot can be cured in infancy about six to eight weeks after birth. The orthopedic surgeon discusses various treatment options with the parents. His proposals for correcting the deformation of the foot should be based on a clear understanding of the functional anatomy of the foot, biological reactions of muscles, ligaments, bones.

Ponseti clubfoot treatment is a controlled technique developed by Dr. Ignacio Ponseti more than 50 years ago at the University of Iowa (USA) and extremely well-proven. The Ponseti technique was introduced in the UK in the late 1990s and popularized throughout the country by physiotherapist of the National Health Service Steve Wild. In the 2000s, the method was widely used thanks to Dr. John Herzenberg in the US and Europe, and thanks to the surgeon of the National Health Service of the United Kingdom, Steve Mannayon, in Africa.

Now treatment of clubfoot in Ponseti is considered the "gold standard" in most developed countries.

Therapy begins in the first-second week of the child's life, with the rectification phase, when manipulation of the tendons and ligaments of the foot does not cause pain. After each procedure, a plaster bandage is used to maintain the degree of correction achieved. It is imposed from the toes to the groin, once a week in a new position for five to seven weeks (depending on the severity of the clubfoot). During this process, the bones of the foot gradually become aligned.

If no correction is needed after the treatment, in most cases a tenotomy is performed - the division by the operative way of the calcaneal tendon, which requires an elongation, since with clubfoot it is always shortened. Under local anesthesia, it is completely divided across the scalpel. Full dorsal extension of the foot is achieved. Then, once again, put a plaster bandage on the foot for three or four weeks.

After tenotomy, the stage of fixation of correction results comes with the help of special therapeutic footwear (braces or "Denis Brown's tires") on a metal sliding rail that fixes the feet in a certain position, correcting the residual deformation in the ankle area. After three or four months, wearing braces can be reduced to fifteen hours a day, later they can only be used during night's sleep. Wear braces up to two to four years in order to avoid recurrence of clubfoot.

Almost 150,000 children are born in the world every year with clubfoot. Treatment of clubfoot in Ponseti is painless, successful in almost 100 percent of all cases of congenital pathology, saving on expensive operations a technique.