This 1963 landmark paper by Ponseti and Smoley reports outcomes of a systematic manipulation-and-casting protocol for severe congenital clubfoot. Sixty-seven patients (94 feet) were treated at the University of Iowa from 1948–1956 and followed 5–12 years. The central question: can severe clubfoot be durably corrected without bone surgery using a defined, reproducible non-operative technique?
When you see a newborn with clubfoot, the Ponseti method described in this paper is why you reach for casting, not a scalpel.
Before this work, extensive open posteromedial release was the dominant treatment — it corrected the deformity but left feet stiff, scarred, and prone to long-term arthrosis. This paper demonstrated that 71% of even severe feet could achieve good results without bone surgery, using a precise, teachable manipulation sequence.
In clinic, the sequence matters as much as the casts: correct cavus first by supinating the forefoot, then address adduction and inversion, and address equinus last with tenotomy if needed. When a family asks if they really need to keep the brace on at night, this paper is your answer: half of all recurrences in this series happened within months of families stopping the Denis Browne splint on their own.
The residual lesson worth carrying into every clubfoot follow-up: recurrence is common (56%), but it is manageable with early casting, and the vast majority of feet never need open surgery if the protocol is followed faithfully.
This 1963 landmark paper by Ponseti and Smoley reports outcomes of a systematic manipulation-and-casting protocol for severe congenital clubfoot. Sixty-seven patients (94 feet) were treated at the University of Iowa from 1948–1956 and followed 5–12 years. The central question: can severe clubfoot be durably corrected without bone surgery using a defined, reproducible non-operative technique?
When you see a newborn with clubfoot, the Ponseti method described in this paper is why you reach for casting, not a scalpel.
Before this work, extensive open posteromedial release was the dominant treatment — it corrected the deformity but left feet stiff, scarred, and prone to long-term arthrosis. This paper demonstrated that 71% of even severe feet could achieve good results without bone surgery, using a precise, teachable manipulation sequence.
In clinic, the sequence matters as much as the casts: correct cavus first by supinating the forefoot, then address adduction and inversion, and address equinus last with tenotomy if needed. When a family asks if they really need to keep the brace on at night, this paper is your answer: half of all recurrences in this series happened within months of families stopping the Denis Browne splint on their own.
The residual lesson worth carrying into every clubfoot follow-up: recurrence is common (56%), but it is manageable with early casting, and the vast majority of feet never need open surgery if the protocol is followed faithfully.