Ponseti and Smoley report 5–13 year outcomes for 67 patients (94 feet) with severe congenital clubfoot treated from 1948–1956 at the University of Iowa. All patients were under 6 months at presentation with no prior treatment. The study asks whether sequential manipulation, serial casting, selective Achilles tenotomy, and Denis Browne bracing can achieve durable correction without extensive soft-tissue release surgery.
For decades, severe clubfoot meant extensive posteromedial soft-tissue release — an operation notorious for producing stiff, painful feet, frequent recurrences, and overcorrection. Ponseti's 1963 series showed that 99% of severe feet could achieve good or acceptable outcomes with casting, tenotomy, and bracing alone.
When you see a newborn with clubfoot, start casting within the first weeks of life. Follow the correction sequence: cavus first, then varus and adduction together, then equinus last. Plan for percutaneous Achilles tenotomy in roughly 4 out of 5 feet.
Counsel families aggressively about bracing before the casts come off. Half of all recurrences trace directly to early splint discontinuation, and that is entirely preventable. Denis Browne splints should be worn full time for 3 months, then nightly until age 3–5.
When recurrence does occur with persistent supination, the answer is tibialis anterior transfer to the third cuneiform, not medial release. Laaveg and Ponseti (1980) confirmed these results hold at long-term follow-up, cementing this protocol as the global standard and a defining example of how Level IV evidence can change practice worldwide.
Ponseti and Smoley report 5–13 year outcomes for 67 patients (94 feet) with severe congenital clubfoot treated from 1948–1956 at the University of Iowa. All patients were under 6 months at presentation with no prior treatment. The study asks whether sequential manipulation, serial casting, selective Achilles tenotomy, and Denis Browne bracing can achieve durable correction without extensive soft-tissue release surgery.
For decades, severe clubfoot meant extensive posteromedial soft-tissue release — an operation notorious for producing stiff, painful feet, frequent recurrences, and overcorrection. Ponseti's 1963 series showed that 99% of severe feet could achieve good or acceptable outcomes with casting, tenotomy, and bracing alone.
When you see a newborn with clubfoot, start casting within the first weeks of life. Follow the correction sequence: cavus first, then varus and adduction together, then equinus last. Plan for percutaneous Achilles tenotomy in roughly 4 out of 5 feet.
Counsel families aggressively about bracing before the casts come off. Half of all recurrences trace directly to early splint discontinuation, and that is entirely preventable. Denis Browne splints should be worn full time for 3 months, then nightly until age 3–5.
When recurrence does occur with persistent supination, the answer is tibialis anterior transfer to the third cuneiform, not medial release. Laaveg and Ponseti (1980) confirmed these results hold at long-term follow-up, cementing this protocol as the global standard and a defining example of how Level IV evidence can change practice worldwide.