The Ponseti method, which is used in the treatment of congenital clubfoot of young children, is today recognized as the most effective and sparing for the baby’s health. In the world, it is accepted as the "gold standard" for treating clubfoot.
Definition of congenital clubfoot
Congenital clubfoot is a complex violation of the structure and function of the foot and lower leg. Violations are present not only in the bones, joints and muscles, but also in the tendons, nerve endings or vessels.
According to statistics, clubfoot is found in 5% of newborn babies. Clubfoot is formed in the initial weeks of pregnancy, its cause has not yet been determined. According to some assumptions, this is due to poor heredity, since in the presence of such a disease in one of the parents, the probability of the manifestation of the disease increases by 4%.
Congenital clubfoot is single or double sided and is more common in boys. The disease is based on the pathological proliferation of connective tissue, which is why the deformation of the foot occurs. In this case, the muscles are shortened, rapprochement and turning inward of the back and inner surface of the foot occurs. A child will never be able to put the leg in its normal position.
Standard treatments for clubfoot
Previously, before the Ponseti method began to be applied, clubfoot was corrected using corrective dressings made of gypsum, and then an operation was performed on the foot, in which lengthening and stitching of the tendons of several muscles occurs, the ligaments of the foot intersected, and the joint was opened. There were frequent cases of affecting and bones on the foot during surgery.
The usual treatment for clubfoot involves the following steps:
- start treatment with a 1-week-old baby;
- first, massage sessions (1-2 weeks);
- alternation of plaster dressings and paraffin applications, which are done over a long period of time: from several months to 2 years, depending on the severity of the pathology;
- final casting for a period of 5 months;
- with low effectiveness of treatment at the age of 2 years, the child undergoes surgery (Z-shaped plastic of the Achilles tendon).
According to statistics, the standard treatment method is 58% effective.
What is the Ponseti technique
Ignacio Ponseti is an outstanding American orthopedist who developed a new method of treating clubfoot in the 1950s and 60s. It is based on a detailed study of the structure of the child’s foot and its pathological changes. Unlike traditional methods of treatment, this method allows you to make a correction quite quickly: 1.5-2 months are allotted for a complete correction, but subject to the timely start of casting.
The Ponseti method allows you to correct the deformation of the foot in a conservative way, avoiding cicatricial changes in the joints, helps to maintain the motor capabilities of the foot and muscles.
The most important condition for the high efficiency of this technique is early diagnosis of the disease (in the first week of life), while the joints and muscles of the child have high elasticity. Treatment should begin at the age of 1-2 weeks of the baby's life, be sure to start walking.
If the deformation is detected later, then the Ponseti method is also possible, however, in time the correction of the defect will be much longer.
Ponseti Treatment Steps
The treatment of clubfoot according to the Ponseti method consists of several successive stages of treatment:
- Correction of deformation using plaster casts, which must be changed every 6-7 days. The child’s leg is completely gypsum: from the fingers to the upper thigh. Each bandage is done in a specific position, allowing you to adjust the shape of the foot and even bones. In total, it is necessary to carry out 4-7 procedures for gypsum legs, but their number depends directly on the severity of the disease and the age of the baby.
- The next stage is achillotomy, i.e., lengthening of the Achilles tendon, which is always shortened with clubfoot. Most often, a closed operation is performed under local anesthesia (for children under 2 years old). After the operation, gypsum is applied for 3 weeks to fix the result.
- The last important step is the use of braces, consisting of two boots fixed on a special sliding bar.
For high efficiency and guarantee of cure from this disease, the high qualification of the doctor conducting the procedure is of great importance.
Plastering Technique
Ponseti casting is carried out weekly, and with each subsequent application of gypsum, a certain type of foot deformation is eliminated. When applying a bandage, a doctor who correctly aligns the foot, and an assistant directly performing the casting participate.
Gypsum is applied in the form of a boot for the entire length of the leg, only the phalanges of the toes are left free to control the blood supply to the vessels and to avoid being crushed by the gypsum.
There are several mandatory rules that must be strictly observed to avoid errors during treatment:
- the first casting allows you to restore the angle of the foot and its internal rotation in the front (cavus);
- when plastering, the knee joint is fixed in a bent position, which will prevent the dressing from shifting and avoid rubbing the delicate skin of the child;
- with each procedure, the angle of the foot should be less than 15 degrees;
- when changing gypsum, the foot should not be in a free position for more than 1 hour;
- 2-4 procedures are aimed at correcting deviations inside the fingers (varus deformity) and at eliminating the plantar fold;
- 5th step - allows you to adjust the heel abduction above the talus, while the doctor fixes the normal foot to the desired position with the help of a splint (the exception is excessive bending in the ankle due to a shortened tendon).
The number of procedures should be no more than 6. The photo and the sequence perfectly demonstrate the corrective castings based on the Ponseti method.
If the attending physician does more procedures, then this will already be treatment not according to the American method and may be harmful. At the subsequent stages, achillotomy and selection of braces are done.
Achillotomy
Ponseti treatment provides in some cases before the 4th or 5th stage of casting an achillotomy, in which:
- the calcaneal tendon is ligated (subcutaneous surgery);
- fixation of damaged ligament endings;
- the operation is done under local anesthesia;
- at the end of the operation, plastering is performed for the next 3 weeks.
This operation is fundamentally different from the standard surgical intervention, which is performed with the standard correction method. During its holding, the child is not given general anesthesia and after it there is no large scar, which subsequently usually limits the mobility of the patient’s foot.
Using braces
The Ponseti method provides, as the final stage, to wear braces and special shoes, which allows you to fix the position of the feet and legs in the right position with the help of the bar to avoid the return of clubfoot. Shoes are selected and ordered in advance.
Wear braces should be around the clock for 3 months, remove only while bathing or changing clothes.
In the future, they will need to be worn only for sleep (day and night) - the recovery period lasts 2-4 years to avoid relapse.
Disadvantages of the method
According to the reviews of parents who used the Ponseti method in the treatment of clubfoot, the disadvantages are as follows:
- the high cost of special shoes (braces), which are usually purchased from manufacturers in Germany or the USA;
- the duration of its delivery to other countries,
- relative fragility of the structure.
In recent years, the company "Bear" has launched the production of domestic counterparts, and when purchasing braces there is the possibility of acquiring them through a social insurance fund.
Method Advantages
The high efficiency of the clubfoot correction method has been proved by the results of 50 years of research at the Dr. Ponseti Specialized Center (University of Iowa, USA), and the technique has been tested in many medical institutions around the world.
Of all the other methods that treat congenital clubfoot, the Ponseti method is the most traumatic, safe and does not depend on the severity of the origin of the deformity. The wearing time of the plaster cast is much shorter than with other methods. Efficiency in correcting foot deformity is 95% of cases.
With the right treatment, the child will no longer have any deformations: he can wear ordinary shoes, there are no contraindications to sports and physical activity.
Ponseti Method: Reviews
Judging by the reviews of parents who treated children for congenital clubfoot with the American method, the effect is positive for almost everyone. Mommies express special enthusiasm, who tried to treat children at first in the standard way (massage + gypsum), after which some patients almost remained disabled. Having later turned to medical centers for doctors who professionally use the Ponseti method for treating clubfoot, parents were able to completely heal the legs of their children.