FOOTPonseti Versus Traditional Methods of Casting for Idiopathic ClubfootHerzenberg, John E. M.D.*; Radler, Christof M.D.†; Bor, Noam M.D.‡Author Information Study conducted at the Maryland Center for Limb Lengthening & Reconstruction, Baltimore, Maryland, U.S.A., and the Emek Central Hospital, Afula, Israel From the *Maryland Center for Limb Lengthening & Reconstruction, Baltimore, Maryland, U.S.A.; †University of Vienna Medical School, Vienna, Austria; and the ‡Emek Central Hospital, Afula, Israel. Address correspondence and reprint requests to John E. Herzenberg, M.D., Sinai Hospital, Rubin Institute for Advanced Orthopedics, International Center for Limb Lengthening, 2401 West Belvedere Avenue, Baltimore, MD 21215, U.S.A. (e-mail: FRCSC@aol.com). Journal of Pediatric Orthopaedics: July-August 2002 - Volume 22 - Issue 4 - p 517-521 Buy Abstract Serial casting is successful in avoiding extensive posteromedial release (PMR) in only 11% to 58% of patients with idiopathic congenital clubfoot. Extensive open surgery is commonly associated with long-term stiffness and weakness. Ponseti claims to avoid PMR in 89% of cases by using his specific technique of manipulation, casting, and limited surgery. The authors report their first 27 patients undergoing the Ponseti technique (34 feet) with a group of 27 matched control patients (34 feet). All patients underwent serial casting, begun within the first 3 months of life. The parameter studied was the need to perform PMR within the first year of life. In the Ponseti group, only 1 (3%) of 34 feet required PMR. In 31 (91%) of 34 feet, percutaneous Achilles tenotomy was performed at age 2 to 3 months. The average duration of casting was 2 months. In the control group, 32 (94%) of 34 feet required PMR within the first year of life, despite a longer casting period. Based on the authors' initial success with the Ponseti method, they no longer believe that PMR is required for most cases of idiopathic clubfoot. Foot abduction splints are crucial to avoid recurrence. Longer follow-up will determine whether the authors can continue to match Ponseti's reported outcomes. © 2002 Lippincott Williams & Wilkins, Inc.