Sequence of Correction: (Ponseti)-
- correction of cavus:
- correction of adduction and heel varus:
- correction of equinus:

2005 National Association of Orthopaedic Nurses Volume 24(1), January/February 2005, p 25–30 Shawne Faulks, MSN, RN, CNS , Texas Scottish Rite Hospital for Children, Dallas, Texas. Brenda Luther, MS, RN , Shriners Hospitals for Children, Salt Lake City, Utah. Clubfoot is one of the most common pediatric orthopaedic conditions. Until recently, surgical management was the treatment of choice. Nonoperative treatment techniques, including the Ponseti casting and French physical therapy methods, have peeked interest of orthopaedists eager to find a less aggressive treatment method that can assure a lasting, good result. Both methods have proven successful in reducing the number of patients requiring extensive surgical release and, as a result, have become an integral part of pediatric orthopaedic practice. A clear understanding of both treatment methods is important for the orthopaedic nurse to allow quality nursing care and help assure a successful outcome for young patients.

Wheeless' Textbook of Orthopaedics
Talipes Equinovarus/Clubfoot
congenital clubfoot is a structural foot deformity that is present at birth;
- there is in utero malalignment of the talocalcaneal, talonavicular and calcaneocuboid joints;
- articular malalignments are fixed by contracted joint capsules, ligaments, and contracted foot and ankle tendons;
- may be bilateral in up to 50%;
- occurs in about 1 out of 800 births;
- more common in males than females;

- Postural clubfoot:
- Moderate Club Foot; - Severe Club Foot: - Hind Foot:

Review article by Minoo Patel in eMedicine
Clubfoot can be classified as (1) postural or positional or (2) fixed or rigid. Postural or positional clubfeet are not true clubfeet. Fixed or rigid clubfeet are either flexible (ie, correctable without surgery) or resistant (ie, require surgical release, though this is not entirely true according to the Ponseti experience).
The Pirani, Goldner, Di Miglio, Hospital for Joint Diseases (HJD), and Walker classifications have been published, but none are universally used.

congenital clubfoot is a structural foot deformity that is present at birth;
- there is in utero malalignment of the talocalcaneal, talonavicular and calcaneocuboid joints;
- articular malalignments are fixed by contracted joint capsules, ligaments, and contracted foot and ankle tendons;
- may be bilateral in up to 50%;
- occurs in about 1 out of 800 births;
- more common in males than females;

200 pictures and video to learn the French treatment of clubfeet

Global Help Manual on the Ponseti Method of Clubfoot management. Download versions in different languages

Roye et al. Pediatrics in Review.2004; 25: 124-130. requires subscription or Pay per View

Background: Clubfoot, or talipes equinovarus, is a congenital deformity consisting of hindfoot equinus, hindfoot varus, and forefoot varus. The deformity was described as early as the time of Hippocrates. The term talipes is derived from a contraction of the Latin words for ankle, talus, and foot, pes. The term refers to the gait of severely affected patients, who walked on their ankles.
Synonyms and related keywords: talipes equinovarus, hindfoot equinus, hindfoot varus, forefoot varus, myelomeningocele, arthrogryposis multiplex congenita, tibial hemimelia

Images from eMedicine articles. Unfortunately you cannot get back to the original articles from this page but it a interesting source of images

Factors Predictive of Outcome After Use of the Ponseti Method of Clubfoot Treatment Dobbs et al. J Bone Joint Surg Am.2004; 86: 22-27 Requires subscription or pay per view

Review of article - Factors Predictive of Outcome After Use of the Ponseti Method for the Treatment of Idiopathic Clubfeet Interesting finding that parental compliance was the most important predictor of success.

Gait analysis data are enhancing researchers' understanding of the functional implications of operative and nonoperative clubfoot therapies, as evidenced by two studies presented in March at the annual meeting of the American Academy of Orthopaedic Surgeons.
Biomechanics June 2006

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