The Ponseti method reduces surgical intervention
By Walter A. Nance Jr., OTC

Reprinted with permission from the Journal of the National Association of Orthopaedic Technologists, Vol. 9, Issue 2.

Clubfoot is one of the most common congenital deformities. Talipes equinovarus, better known as clubfoot, is present in one out of every 800 births. This idiopathic congenital condition is sometimes misdiagnosed as other congenital abnormalities such as metatarsus varus (adductus) (Dobbs, 2000). This article examines idiopathic congenital clubfoot that occurs in otherwise normal infants, its different components, and the Ponseti method (named after its inventor IN. Ponseti, MD) of treating this condition.

Clinical anatomy
The functional anatomy of clubfoot and the structural changes in its ligaments, tendons and muscles require a thorough understanding to arrive at a sound approach to early, nonsurgical treatment of this deformity. Congenital clubfoot is a complex 3-D deformity with four components: equinus, varus, adductus, and cavus. In a healthy foot, the calcaneus moves under the talus by rotating around the fibres of the flexes and inverts (Wheeless, 1996; Roye, 2002).

The midfoot will have no tarsal mobility. Soft tissue creases are easily identifiable in the medial and transverse midfoot. There is displacement of the navicular in relation to the medial malleolus. The cuboid is also medically displaced in relation to the calcaneus, which is fixed to the fibula. Both the forefoot and the midfoot are inverted and adducted. The forefoot cavus is present with a depressed first metatarsal and is common with a fixed-forefoot supination, relative to the hindfoot (Wheeless, 1996; Roye, 2002).

In the hindfoot of a patient with clubfoot, the calcaneus inverts (varus) and the talus lies in a position of rigid equinus with medial rotation in the ankle mortise. This makes the head of the talus palpable at the sinus tarsi. In a more severe deformity, the calcaneus is sometimes difficult to palpate because of the underlying forefoot planter flexion and supination (Wheeless, 1996; Roye, 2002).

Additionally, the midfoot of a patient with clubfoot will have no midtarsal mobility, and soft tissue creases of the medial or transverse midfoot are indicators of a more severe deformity. There is also medial displacement of the navicular, which may abut the medial malleolus. The cuboid is medially displaced in relation to the long axis of the calcaneus, and the os calcis is fixed to the fibula. Both the forefoot and midfoot are inverted and adducted. Forefoot cavus with a depressed first metatarsal is common with fixed forefoot supination relative to the hindfoot (forefoot varus) (Wheeless, 1996).