Boots & Bar
Dr. Ignacio Ponseti was born in Menorca, Spain 1914 and worked as a physician during the Spanish civil war. During this time, he specialized in orthopedic care, caring for the soldiers' various broken bones. In the early 1940s he came to University of Iowa to study under Arthur Steindler, M.D., a pioneer in orthopedic medicine and a world-recognized surgeon. After Dr. Ponseti finished his residency, he began teaching and practicing at the University hospital. During this time he witnessed many cases of clubfoot that were treated surgically, causing long-term problems, namely limited mobility and pain. In the 1950s he developed the Ponseti Method, a non-surgical method that involved a series of plaster casts, and a brace to hold the positioning of the foot. This method was not widely used until the 1990s, but is now considered the best method of correction for clubfoot.
Part 1: Correction
Part 2: Maintaining Correction
and Preventing Relapse
Correction starts shortly after birth to allow for the most flexibility of tendons and ligaments. The practitioner will gently stretch the foot and set in a plaster cast every 5-7 days until it reaches a corrected position.
It usually takes 5-7 weekly casts, but can take more if the foot is atypical/complex. Once the foot has reached a corrected position, a "Achilles (heel cord) tenotomy" (also known as a Percutaneous Achilles Tenotomy) will take place, normally under local anesthesia. Not all babies will need this procedure, but almost 90% of cases will. This final cast will stay on for approximately 3 weeks, while the Achilles tendon heals.
After the final cast is removed, a baby is placed into an orthopaedic brace or "boots and bar" as it is referred to, which leads us to part 2 of The Ponseti Method of treatment!
Immediately after the final cast is removed, a baby will be fitted and placed into his or her "boots and bar" brace.
The brace consists of two AFO boots, connected by a bar. If treatment started at birth, typical protocol requires 23 hour wear the first 3 months, followed by a slow weaning to approximately 14 to 16 hours a day.
Current recommendation is that the brace is continued to be worn until the age of 4, however, many parents choose to continue with the brace until they size out of the AFOS. This is because relapse rates decrease each year a child wears the brace. The bulk of time in brace is at night to maintain correction while sleeping.
Video by Mobility Outreach International