| What is the Ponseti Method?
This is a technique that is gaining popularity in this country. Professor Ignacio Ponseti in Iowa, USA, developed it over 40 years ago. He has been able to follow the progress of some of his patients to adulthood and the results are very good. Many of his patients have flexible pain-free feet. The method uses manipulation and casting, followed by boots with a bar. On the Internet it is sometimes refereed to as a non-surgical technique. This is a little misleading, as 80% - 95% of children may need a small operation to lengthen the Achilles tendon (a tenotomy). However it does seem to reduce the need for more extensive surgery.
Dr Ponseti's list of practitioners can be viewed here
Ideally it is best to start the Ponseti Method within a few weeks of the birth, but older babies have been treated successfully. The method will not be suitable if your baby has already had the more extensive surgery at the back of the heel and round the side of the foot.
What does the treatment involve?
The method requires a series of precise manipulations, gently rotating the bones and stretching the soft tissue. Your baby will not find it painful, though some will object to being held in the same position. A plaster cast from the toes to the groin is then applied. The casts are changed every 5 - 7 days and most children need between 6- 10 casts. The position of the feet gradually improves until they are pointing outwards. It is when this degree of correction has been obtained that your surgeon will look at the tightness of the heel. Many babies still have a tight heel cord (Achilles tendon) so will require a small operation called a tenotomy to lengthen it. This requires a small cut (approximately 3mm) a little above the back of the heel. Many surgeons do this under a local anesthetic. The baby's foot and leg are then put in a cast which is worn for 2 - 3 weeks.
What happens next?
When this final cast is removed both feet are put into boots that are connected by a metal bar. It is similar to a British splint called the Denis Browne splint, but the positioning of the feet and the length of the bar is very accurately calculated. This helps to maintain the correction.
These boots are usually worn for day and night for 3mths. After this the boots are worn at night and "nap" time until your child is approximately 4 years old. During the day ordinary well-fitting shoes can be worn.
Many parents feel this is the most difficult part of the treatment. Babies can become distressed when they are first put into the boots with the bar. It is vital to persevere, as this is a very important part of the treatment. Not persevering with the wearing of the boots with the bar nearly always results in the child requiring more treatment with plaster casts or repeat surgery.
A small number of children may need surgery, involving a tendon transplant around the age of 4-7years.
It is during the early days of this part of the treatment that you may feel you need most support. Talking to other parents in the same situation can be beneficial. This can be done face to face in some of the bigger clinics, through the steps Contact Register or in Chat Rooms on the Internet. The steps Discussion Forum is a good place to start. The important thing to remember is NOT TO GIVE UP.
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Written May 2003. External review by Paediatric Orthopedic Consultant May 2003 | 
