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Ponseti Checklist

Many doctors/physiotherapists claim to be proficient in the Ponseti method, but are not adhering to the exact procedure developed by the pioneer, Dr Ponseti himself. There are casting methods that predate the Ponseti method and these should not be confused with bring the same treatment.

To ensure that your child is receiving the ‘true’ Ponseti Method please take a look at the basic requirements below:

The Ponseti casts are full length casts. The knee should be bent to 90-100 degrees, they should extend from the toes to the groin (not mid or upper thigh) and should be well moulded onto the foot. The cast should be cut at the toes to make them clearly visible in the top with a firm platform at the bottom for the toes to rest.

For newborns, unless the foot is very stiff, only about 5-6 casts should be used (95% of the cases). If the doctor has to use more than eight casts, her/his casting technique is probably not well perfected. Each time a new cast is placed the outward rotation of the foot should change by about 10-15 degrees. The last cast should be set to about 60-70 degrees of abduction (external rotation).

Most children treated with this method will need a heel cord tenotomy.  It is done when the foot is corrected except for a tight heel cord, so it is done before the final cast is put on and never before. The procedure will most likely be done under local anaesthetic and no stitches are necessary. The last cast, put on after the tenotomy will be left on for 2-3 weeks to help with healing.

The boots and bar should be fitted the same day the last cast is taken off. Do not wait a few days to get the boots and bar as this will result in difficulty setting the heel down into the boot and that may lead to problems with the brace (red spots or even blisters) and an early relapse.

If your doctor/physiotherapist is deviating from the above and you are at all concerned please do not hesitate to call the Steps Helpline 01925 750271 or email us for further information.