SciELO - Scientific Electronic Library Online

vol.8 issue4 author indexsubject indexarticles search
Home Pagealphabetic serial listing  

Services on Demand



Related links

  • On index processCited by Google
  • On index processSimilars in Google


SA Orthopaedic Journal

On-line version ISSN 2309-8309
Print version ISSN 1681-150X

SA orthop. j. vol.8 n.4 Centurion Jan. 2009




Early results of the Ponseti technique for a clubfoot clinic in South Africa



GB FirthI; M EltringhamII; IIIG ShnierIII

IMBBCh, FCS(SA)Orth, MMed(Rand)(Orth); Consultant Orthopaedic Surgeon, Chris Hani Baragwanath Hospital. Division of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg
IIMBBCh, FCS(SA)(Orth); Consultant Orthopaedic Surgeon, Sunninghill Hospital. Division of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg
IIIHN Dip Med Proth Orth (Tut SA), Honours(Med Proth Orth)(Tut SA); Orthotist Prosthetist , Sunninghill Hospital. Division of Orthopaedic Surgery, University of the Witwatersrand, Johannesburg





An audit was performed at a South African clinic in an attempt to compare results with those already published internationally. The aim was to determine the outcome and need for further surgery using this technique. A retrospective review was performed of a single surgeon practice using the Ponseti technique on all patients presenting with a clubfoot deformity.
Patients with less than one year of final follow-up were excluded. A total of 70 patients were reviewed (106 feet). Patients were seen at a mean age of 3 months and 20 days. A mean of 6.5 casts were applied. The Achilles tenotomy rate was 74% (78 feet). A good outcome with complete correction was achieved in 63 feet (59%). Overall recurrence requiring re-plastering occurred in 24 feet (23%) and further surgery (other than Achilles tenotomy) was required in seven feet (7%).
The Ponseti technique is a successful and rewarding method of treating all children with clubfeet. The technique must be done according to Ponseti's principles with attention to detail, rigorous parent education and close follow-up. Prior treatment was not associated with a worse outcome. Greater awareness and education regarding the Ponseti technique is mandatory to ensure early successful treatment.


“Full text available only in PDF format”




1. Kite JH. Nonoperative treatment of congenital clubfoot. J Bone Joint Surg [Am] 1939;21-A:595-606.

2. Richards BS, Faulks S, Rathjen KE, Karol LA, Johnston CE, Jones SA. A comparison of two nonoperative methods of idiopathic clubfoot correction: the Ponseti method and the French functional (physiotherapy) method. J Bone Joint Surg [Am] 2008;90-A:2313-21.

3. Ponseti IV, Smoley EN. Congenital clubfoot. The results of treatment. J Bone Joint Surg [Am] 1963;45-A:261-344.

4. Cooper DM, Dietz FR. Treatment of idiopathic clubfoot. A thirty-year follow-up note. J Bone Joint Surg [Am] 1995;77-A:1477-89.

5. Bor N, Coplan JA, Herzenberg JE. Ponseti treatment for idiopathic clubfoot. Minimum 5-year follow up. Clin Orthop Relat Res 2009;467:1263-70.         [ Links ]

6. Laaveg SJ, Ponseti IV. Long term results of treatment of congenital club foot. J Bone Joint Surg [Am] 1980;62-A:23-31.

7. Morcuenede JA, Abbasi D, Dolan LA, Ponseti IV. Results of an accelerated Ponseti protocol for clubfoot. J Pediatr Orthop 2005;25(5):623-26.         [ Links ]

8. Dobbs MB, Rudzki JR, Purcell DB, Walton T, Porter KR, Gurnett CA. Factors predictive of outcome after use of the Ponseti method for the treatment of idiopathic clubfeet. J Bone Joint Surg [Am] 2004;86-A:22-7.

9. Shack N, Eastwood DM. Early results of a physiotherapist-delivered Ponseti service for the management of idiopathic congenital talipes equinovarus foot deformity. J Bone Joint Surg [Br] 2006;88-B:1085-9.

10. Janicki JA, Narayanan UG, Harvey BJ, Roy A, Weir S, Wright JG. Comparison of surgeon and physiotherapist directed Ponseti treatment of idiopathic clubfoot. J Bone Joint Surg [Am] 2009;91-A:1101-8.

11. Pirani S, Naddumba E, Mathias R, Konde-Lule J, Norgrove Penny J, Beyeza T, Mbonye B, Amone J, Franceschi F. Towards effective Ponseti clubfoot care. The Uganda sustainable clubfoot care project. Clin Orthop Relat Res 2009;467:1154-63.         [ Links ]

12. Willis RB, Al-Hunaishel M, Guerra L, Kontio K. What proportion of patients need extensive surgery after failure of the Ponseti technique for clubfoot? Clin Orthop Relat Res 2009;467:1294-7.         [ Links ]

13. Dyer PJ, Davis N. The role of the Pirani scoring system in the management of club foot by the Ponseti method. J Bone Joint Surg [Br] 2006;88-B:1082-4.

14. Dimeglio A, Bensahel H, Souchet Ph, Mazeau Ph, Bonnet F. Classification of clubfoot. J Pediatr Orthop 1995;4:129-36.         [ Links ]

15. Scher DM, Feldman DS, van Bosse HJP, Sala DA, Lehman WB. Predicting the need for tenotomy in the Ponseti method for correction of clubfeet. J Pediatr Orthop 2004;24(4):349-52.         [ Links ]

16. Bensahel H, Dimeglio A, Souchet Ph. Final evaluation of clubfoot. J Pediatr Orthop B 1995;4:137-41.         [ Links ]

17. Bensahel H, Kuo K, Duhaime M. The International Clubfoot Study Group. Outcome and evaluation of the treatment of clubfoot: the international language of club foot. J Pediatr Orthop B 2003;12:269-71.         [ Links ]

18. Gupta A, Singh S, Patel P, Patel J, Varshney MK. Evaluation of the utility of the Ponseti method of correction of clubfoot deformity in a developing nation. International Orthopaedics (SICOT) 2008;32:75-9.         [ Links ]

19. Avilucea FR, Szalay EA, Bosch PP, Sweet KR, Schwend RM. Effect of cultural factors on outcome of Ponseti treatment of clubfoot in rural America.         [ Links ]



Dr GB Firth
Dept of Orthopaedics
Wits Medical School
Tel: (011) 717-2538; Fax: (011) 717-2551



This article is the sole work of the authors. No benefits of any form are to be received from a commercial party related directly or indirectly to the subject of this article.

Creative Commons License All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License