Foot deformity will correct more rapidly when treatment is initiated early. Ideally babies should be referred within 2 or 3 weeks of birth although Ponseti manipulation and casting can be effective up to approximately 2 years of age.
Babies are seen every week and the foot sequentially stretched for several minutes. A cast is then applied in the corrected position. The cast usually extends from the toes to the groin and is applied with the knee bent at 90 degrees. The cast is soaked and removed before each visit. The majority of the deformity will generally have corrected within 4 to 8 weeks although in approximately 90% of cases the heel cord (Achilles tendon) will still be tight. If so this is surgically lengthened (Achilles tenotomy)
Achilles tenotmy involves a small incision approximately 5mm long just above the heel. This can either be done using local anaesthetic with the baby awake or under a short general anaesthetic. A cast is then applied for 3 weeks while the tendon heels in an elongated position.
After 3 weeks the final cast is removed. The foot position is then maintained in a brace (boots + bar). This has to be applied to both feet even if only one is treated. Initially the brace is worn almost full time (23 hrs per day). After 3 months it is used at night time and when the baby sleeps during the day if possible until 4 years of age.
Patients are reviewed every 3-6 months to asses progress and change boots. In the majority of cases an excellent result can be expected although the involved foot will always be 1-2 sizes smaller than the uninvolved side. In approximately 10-15% of cases a small operation may be necessary at around 3 years of age if the child has a tendency to walk on the outside of the foot.