Ponseti's 1992 Current Concepts Review codifies his manipulative treatment of congenital clubfoot. It describes the precise correction sequence, cast technique, percutaneous tenotomy indications, bracing protocol, and management of relapse. It also explains why forcible pronation — the most common technical error — produces iatrogenic deformity rather than correction.
When you see a newborn with clubfoot, the Ponseti method is the starting point — not posteromedial release. Before this paper was widely adopted, many centers used forcible pronation during manipulation, producing rocker-bottom deformity and mid-foot breach rather than correction. Extensive surgical release was often the default, carrying risks of talar necrosis, stiff joints, wound complications, and overcorrection.
In practice: correct cavus first by supinating the forefoot, then abduct in external rotation using the talar head as a fulcrum, and save equinus for last. Use a toe-to-groin cast with the knee at 90°. A below-knee cast cannot hold external rotation.
Expect to perform Achilles tenotomy in 7 out of 10 patients. After correction, brace compliance is everything: half of patients will relapse without it, and the brace must be worn nightly until age 3–4. The clinical pearl worth remembering: a talocalcaneal angle outside the normal range on X-ray does not indicate failure. Judge the result clinically, not radiographically.
Ponseti's 1992 Current Concepts Review codifies his manipulative treatment of congenital clubfoot. It describes the precise correction sequence, cast technique, percutaneous tenotomy indications, bracing protocol, and management of relapse. It also explains why forcible pronation — the most common technical error — produces iatrogenic deformity rather than correction.
When you see a newborn with clubfoot, the Ponseti method is the starting point — not posteromedial release. Before this paper was widely adopted, many centers used forcible pronation during manipulation, producing rocker-bottom deformity and mid-foot breach rather than correction. Extensive surgical release was often the default, carrying risks of talar necrosis, stiff joints, wound complications, and overcorrection.
In practice: correct cavus first by supinating the forefoot, then abduct in external rotation using the talar head as a fulcrum, and save equinus for last. Use a toe-to-groin cast with the knee at 90°. A below-knee cast cannot hold external rotation.
Expect to perform Achilles tenotomy in 7 out of 10 patients. After correction, brace compliance is everything: half of patients will relapse without it, and the brace must be worn nightly until age 3–4. The clinical pearl worth remembering: a talocalcaneal angle outside the normal range on X-ray does not indicate failure. Judge the result clinically, not radiographically.