Research Article: Good results with the Ponseti method

Date Published: June 4, 2012

Publisher: Informa Healthcare

Author(s): Christian Sætersdal, Jonas M Fevang, Lars Fosse, Lars B Engesæter.


In 2002–2003, several hospitals in Norway introduced the Ponseti method for treating clubfoot. The present multicenter study was conducted to evaluate the initial results of this method, and to compare them to the good results reported in the literature.

116 children with 162 congenital idiopathic clubfeet who were born between 2004 and 2006 were treated with the Ponseti method at 8 hospitals in Norway. All children were prospectively registered at birth, and 116 feet were assessed according to Pirani before treatment was started. 63% used a standard bilateral foot abduction brace, and 32% used a unilateral above-the-knee brace. One of the authors examined all feet at a mean age of 4 years. At follow-up, all feet were assessed by Pirani’s scoring system, and range of motion of the foot and ankle was measured.

At follow-up, 77% of the feet had a Pirani score of 0.5 or better, good dorsiflexion and external rotation, and no forefoot adduction. An Achilles tenotomy had been performed in 79% of the feet. Compliance to any brace was good; only 7% were defined as non-compliant. Extensive soft tissue release had been performed in 3% of the feet.

After introducing the Ponseti method in Norway, the clinical outcome was good and in accordance with the reports from single centers. Only 5 feet needed extensive surgery during the first 4 years of life.

Partial Text

In this multicenter clinical study, all 134 newborns with idiopathic congenital clubfoot treated at 8 hospitals in Norway during the period 2004–2006 met the inclusion criteria. All the children were registered prospectively from birth, and 116 feet were assessed according to Pirani before treatment was started. In March 2009, one of the authors (CS) visited all 8 hospitals and performed a standardized clinical examination of the patients.

The overall initial results of clubfoot treatment presented in this multicenter study are good. We found similar outcome in the two types of braces, but there was a tendency to have better Pirani scores in children using the bilateral foot abduction brace. There was a tendency to have better compliance in children using the unilateral brace. We found better outcome as measured by Pirani score in children who were treated at the largest hospitals.