Ponseti's reply.....let's try this again!

[Guest guest]

WOW!!! I got an email back from Dr. Ponseti this evening. I don't

understand about half of the the terminology, but now I feel armed

with information!!!

This is what he said:

Dear Mrs. Crossley:

After seeing only the picture taken from above, I can say that

iel's right foot appears to be a good deal shorter than the

left and the heel appears to be in varus. The forefoot is severely

adducted about 25 degrees. Without a lateral view of the foot in

dorsiflexion, I don't know if the foot is in plantar flexion or if

the foot has some dorsiflexion.

Since he is 4 1/2 years old, I would try to correct the deformity

without surgery. He will likely need about three or four long leg

casts changed weekly. The correction without surgery depends on the

amount of stiffness in the ligaments of the foot. Most can be

stretched in children gradually with a few casts to soften them.

The heel varus also can be corrected but it is sometimes necessary

to transfer the anterior tibial tendon to the third cuneiform to

prevent another relapse.

If you go to the web site www.global-help.org and click on

Publications, you can download a copy of Clubfoot: Ponseti

Management. In the English version on pages 20-21 this tendon

transfer surgery is outlined.

Osteotomies to correct the adduction of the forefoot are often done

by removing a wedge of bone from the outside, opening up the first

cuneiform on the inner side, and placing the wedge of bone there.

However, this surgery can easily damage the joints so I would try to

avoid it by casting first. The transfer of the anterior tibial

tendon is used to prevent the heel varus from relapsing and at the

same time it is useful in maintaining the forefoot in proper

alignment with the hindfoot.

I.V. Ponseti, M.D.

I'll keep you all posed on the progress.

Thankagain for all the help and support.

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