TSRHC

Ponseti Casting Method

The Ponseti casting method is one of two nonsurgical treatment options Texas Scottish Rite Hospital for Children uses to treat infants born with clubfoot. Ideally, treatment begins within the first two weeks after the child is born. The therapy involves placing a cast that extends from the thigh to the toes after gentle stretching of the foot. The plaster cast is replaced every week, during which time the foot is stretched further and continued gradual improvement is achieved.

For a newborn with congenital clubfoot, major improvement is obtained in four to five weeks. All components of the condition are usually corrected at this point, except for the tightness in the heel cord (equinus).

Once all other components of the clubfoot are corrected by casting, the equinus is corrected by cutting the heel cord to bring the ankle into a normal position.  This  quick procedure is don in the clinic and does not require any anesthesia. Cream is applied to numb the skin after which the doctor performs a heel cord release with an extremely small tool. The cut in the skin is about the size of a pinprick, and no stitching is required.

A final cast is then worn for three weeks to allow the tendon to heal. The child then wears shoes attached to a bar, which maintains the foot in the corrected position. This brace is worn full-time for three months and then used at night until the child is 2 years old.