Casting Phase

 

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Many  physicians  claim to be proficient in the Ponseti method, but they are not. It is not because they are “bad” doctors; it is because the Ponseti method is not taught in medical school, so the only way to learn is through a training program. Also, there are casting methods that predate the Ponseti method, and many doctors do not understand the difference. Below are the basics of the Ponseti method and if your physician is deviating, without a good reason (for instance, if your child is 2 or older there may be some deviations to the method)

 

The Ponseti casts are long leg casts. They should be over the knee (from toe to groin) and well molded onto the foot. Casts should be removed only before a new cast is put on to guard against relapse. Plaster casts are the best material for making Ponseti casts. Some doctors will use soft fiber, that is okay, but it is harder to get the well-molded casts using soft fiber, and there is scientific evidence that the results are worse.  


He does look like an astronaut here...(giggling)

 

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, their method is probably not well perfected. Each time a new cast is used the outward rotation of the foot should change by about 10-15 degrees. The last cast should be set to about 70 of abduction (external rotation).


From left to right, these casts show the increase in outward rotation as prescribed by Dr. Ponseti.

 

 Most children treated with this method will need a heel cord tenotomy (clipping of the tendon). This is the only invasive part of treatment, though it is much less invasive than surgical treatment. It is typically done before the final cast is put on (almost never before). The reason for this procedure is that the heel cord is resistant to stretching. The tenotomy used is called a percutaneous tenotomy, and is different than an open incision, z-lengthening tenotomy or heel cord lengthening.  This procedure will most likely be done under local anesthesia and takes about 10 minutes to perform.  The physician will use a very thin knife and cut the heel cord. No stitches are necessary after this process. The last cast, put on after the tenotomy, will be left on for two and a half to three weeks to help with healing.

The brace should be used  the same day  the last cast is taken off.
Do not wait a few days to get it. It will result on an early relapse. For more information on the brace, read bracing protocols.

 

   Go to Clubfoot Link Section for the sources and references