Ponseti Clubfoot Clinic

Once Case Story of Relapse and his Management

This young man has a very difficult story to share, which I think is very valuable to other families with children who have CTEV.

After being born with CTEV casting was started immediately. He was promptly referred to an orthopaedic surgeon for management. After 5 months he had his achilles tenotomies. Boots and bars bracing was not used. At 7 months of age he had full posterior medial releases which still could not achieve good position of his ankles. At 20 months of age he was referred by his surgeon to see me (as in diagram above) for Ponseti casting, with a planned ilizarov procedure if we failed.

After 6 weeks of casting this was the result and now one year down the track he and his parents are managing with the sleep time bracing and as you can see in the diagram below, he has approx. 25 degrees of dorsiflexion and 30+ degrees of external rotation in both ankles.

If you are experiencing poor results with casting or the only option you have been given is, for your child to have surgery.

I would ask your surgeon for a referral to a centre that is experienced in successfully using the Ponseti method for treating clubfeet.

If carried out correctly, the casting will cause no harm.

Only the inconvenience of managing your child with casts on and coming in weekly to have them done. Also if this fails you have the surgery to fall back on.

The orthopaedic surgeon and the physiotherapist work together as a team to get the best results for your children. Consider that people are doing there best where ever they may be with the techniques they are used to working with and may not be experienced with the Ponseti method. But that is not to say you have to accept what they are offering. So ask for a referral to see us at the CHW if you have concerns.

Please see contacts for the names of our orthopaedic surgeons and physiotherapists. A GP referral to one of our orthopaedic surgeons is all that is required to get the ball rolling, and fax to (02)9845 2702.