Does Your Doctor Follow The Ponseti Method To Correct Clubfoot?
Is your foot doctor using the Ponseti Method to treat clubfoot
? Some foot doctors may "say" they are using the Ponseti Method, but they may be only referring to the fact that they do serial plaster casts, or they may have modified it, or not be following it exactly.
Research has shown that the best results are achieved by following the protocol of the Ponseti Method exactly as developed by Dr. Ponseti. Here are some questions to ask, or things to note, if you are not sure that your doctor is using the true Ponseti Method.
Is the doctor using full leg casts or half leg casts? The answer should be full leg casts. The Ponseti Method uses casts up to the groin and bent at the knee. This helps to immobilize and hold the manipulated foot in the right position so that the ligaments, tendons and skin can grow until the next cast is applied.
How many casts are needed to correct a clubfoot? The answer should be 3 to 6 casts, and maybe a couple more if the clubfoot is very severe and stiff. If your doctor seems vague even after 1 or 2 casts about how many more casts are needed, or tells you to "be patient," then he or she is not following the Ponseti Method correctly. You should also be able to visibly see progress by the shape and angle of the casts.
Is a tenotomy required in most cases? Studies show in over 80% of cases the answer is "yes." This is done in most cases and is the only 'invasive' part of the Ponseti Method. It is typically a procedure done in the surgeon's rooms under local anesthetic and only takes about 10 minutes.
The surgeon first anaesthetizes the area, and then makes a tiny cut with a scalpel at the back of the heel; the Achilles tendon is cut, so that the foot drops down. The final cast is then applied to hold the foot correctly until the Achilles tendon regenerates in the correct position.
What type of brace should a foot doctor use? Your foot doctor should use an FAB (Foot Abduction Brace), also known as the DBB (Denis Browne Bar). This is an aluminum adjustable brace, on which two shoes are attached. Dr. Ponseti says that the distance between the heels should equal the width of the shoulders; this is the most comfortable for the baby.
How long is the FAB (Foot Abduction Brace) worn for? The FAB should be worn for 2 to 3 months of full time wear (23 hours a day), followed by night and naptime wear that reduces gradually from 20 to about 14 hours. By the time the child is 2, brace wear is typically 10-12 hours at night until about 4 years of age.
In a few cases, the child has loose joints and stops the FAB earlier, but it is generally recommended that they stay in it at least until 4 years old. It's important that the doctor follows the bracing protocol and assists you in the first few weeks of your baby adapting.
by: Dr Alireza Khosroabadi DPM
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