A to Z Red Flags in the treatment process


Parents/caregivers may want to seek more information or a second opinion for their child if:


A) Someone other than a pediatric orthopaedic surgeon is doing the casting.

B) The doctor cannot describe his or her training in the Ponseti method.

C) The doctor will not say how many clubfoot patients he or she has managed.

D) The doctor wants to delay the start of treatment. [Ask the reason(s).]

E) Casts slip or fall off.

F) Casts are only below the knee.

G) Casts are to be worn longer than a week.

H) The foot does not improve or looks worse after 2-3 casts.

I) The doctor wants you to remove the cast the day before your appointment.

J) The doctor recommends Posterior-Medial Release (PMR) surgery.

K) The doctor says PMR surgery and the Ponseti method have the same long term results.

L) The doctor does not recognize “atypical/complex” clubfoot nor explain how treatment differs.

M) The doctor is unsure if a tenotomy is needed. [It is in 80% of cases.]

N) A tenotomy is performed before achieving 60-70 degrees of external rotation.

O) The cast stays on for more than four weeks after the tenotomy.

P) The clubfoot brace is applied before the foot is fully corrected.

Q) There is a delay in starting bracing after the last cast is removed.

R) The doctor recommends a brace without a bar or just an Ankle-Foot Orthosis (AFO).

S) The clubfoot side(s) of the brace is not set at 60-70 degrees of external rotation; the non-clubfoot side is not set at 30-40 degrees.

T) The bar is not set to the width of the child’s shoulders.

U) The doctor recommends something other than wearing the brace 23 hours for the first 3 months, then nights and naps, and, later, while sleeping until the age of four.

V) The doctor or orthotist does not show you how to properly apply the brace.

W) The foot continues to slip out of the brace.

X) The doctor wants to do Anterior Tibialis Tendon transfer (ATT) surgery before first re-casting to correct a relapse.

Y) The doctor wants to do ATT surgery before the child is three years old.

Z) Follow-up visits are not scheduled at regular intervals.


This list was developed in conjunction with Ponseti International Association and the information compiled is from Dr. Ponseti's writings and teachings, clubfoot family experiences, and the larger medical community. Doctors and those in the medical field have opinions that may differ. This document is not a substitute for professional medical advice. Consult your doctor with questions. Every clubfoot situation and every clubfoot child's treatment plan may differ slightly.

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