Ponseti metode I think.

Says:-

Thanks for your comment Ms.Debi. Yeah, I am aware of it. That is exactly what I am trying to kindle out of this debate. To my knowledge, not all Ponseti methods were successful.

Now that I have made an open ended comment, let's see how many rave reviews we get on this.

Dear Sai,

You are correct that not all cases of CTEV demonstrates success with Ponseti Tech.

Actually you can follow following sequences to succeed with CTEV from infantile state (3 months onward);

1. Dip the leg in lukewarm water ( that infant skin can tolerate) for 15-25 minutes,

2. Take out each leg alternately and mobilise in the sequence of Forefoor abduction, Subtalar Eversion and then Dorsi Flesion.

Note: Please note that however we have to do all three movement to mobilise the tight structures but do not make it compulsory i.e. if you have so much restriction in forefoot abduction movement to achieve till netutral, then do only only this movement only, till you achieve complete abduction flexibility in forefoot. Once you have achieved forefoot abduction completely , then move on for Subtalar eversion, and follow the same before doing dorsiflexion at talocrural joint.

3. Upon this every mobilisation session, please provide orthosis to child where articulation is available on plantar aspect of the orthosis; means;

you need to have orthosis where you can have;

a. Forefoot abduction option (Dynamic one) and same time this abduction whould be progressive one. Please ensure that the medial flaring componet of the orthosis in forefoot area is blocking the medial splay of the Metatarsals, while lateral flaring is kept open till Tarso-metatarsal joint levels.

b. In the same orthosis please provide calcaneal eversion and do not give and medial arch in the orthosis.

c. Also have the articulation at ankle joint (using Tamrack Flexure DF assist- Small size), while Plantar flexion is stopped till Neutral and option of free DF.

4. Review the orthosis every 2 months as infant feet might grows.

5. Follw this till child reaches top weight standing age (9 months), when weight bearing can be initiated.

6. If you feel that feet is correcting then start training for weight bearing over the feet in standing position without orthosis (giving correct angle to the feet) , but use the orthosis when child is walking.

7. Keep changing the orthoisis every 6 months once child has started walking.

8. Use this orthosis till 3 years of age.

9. I have given the name of this orthosis as "Plantar Articulating CTEV Orthosis".

10. If you feel that equinous is not getting corrected due to altered morphology of Tendoachilles tendon, then refer the child for controlled release of TA. This might happen because of altered vascularity in TA Tendon in CTEV.

I hope this will help you.

My best wishes

Dr. Amitesh Narayan

Prof. and Head

Dept of Physiotherapy

Kasturba Medical College, Mangalore.

Manipal University.

I believe that when you use the Ponseti´s method on newborn's feet (age 3 to 6 months), you can effectively attenuate the foot's positional deformity, but not the torsional deformity in the talar head and posterior aspect of the calcaneus.

In effect, you will end with the PreClinical Clubfoot Deformity that must be treated with appropriate insoles (as Dr Narayan suggests).

Professor Rothbart