Ponseti method

Most children with clubfoot (a condition that causes one or both feet to rotate inwards) see improvement with the Ponseti method. At the Comprehensive Clubfoot Clinic, your child receives high-level care from an orthopedic specialist trained at the center where the method originated.

What Is the Ponseti Method?

The Ponseti method is a highly successful way to treat clubfoot without surgery. It involves gentle manipulations and a series of casts to gradually move a child’s foot into the proper position. Treatment usually starts when a baby is two weeks old and includes:

Manipulation and casting

During this first step in the treatment process, you can expect:

  • Your child’s doctor will gently stretch and move your baby’s foot into a more correct position.
  • After stretching, a thigh-to-toe cast continues to stretch your baby’s foot and holds the foot and leg in the new position. Our cast technicians have specialized training in the Ponseti method. For your baby’s comfort, we use removable, semi-rigid fiberglass casts. This material is more lightweight and breathable than plaster casts.
  • Manipulation and casting occur once a week. It can take up to eight weeks to move the foot into the proper position.

Achilles tenotomy

After manipulation and casting, up to 90% of babies need a minor procedure called an Achilles tenotomy to release a tight Achilles tendon. This tissue cord connects calf muscles to the heel bone. It’s a quick nonsurgical procedure that takes place in the doctor’s office or cast room. During an Achilles tenotomy, your child’s doctor:

  • Injects an anesthetic into the treatment area to numb it. 
  • Uses a small scalpel to cut the skin behind the ankle.
  • Cuts the Achilles tendon.

The incision site is small so your child won’t need stitches. After the procedure, a cast protects the Achilles tendon as it regrows to its new longer length. This process typically takes three weeks. After cast removal, your child’s foot should be in the correct position.


To ensure the foot stays in the corrected position, your baby wears the brace almost full time (23 hours a day) for the first three months. Brace time decreases to naptime and nighttime (about 12 to 14 hours every day) as your baby grows. In total, your child will wear a brace for four to five years.

Depending on your child’s needs, the brace may have custom-made shoes attached to the ends of a solid or moveable bar. We have representatives from bracing companies on-site as part of our orthotics program. As your child grows, these specialists adjust the braces and ensure there’s no disruption in treatment.

Follow-Up Care

A treated foot sometimes wants to return to its clubfoot position. For this reason, we see your child annually after brace treatment until they’re 8 years old. We can quickly spot signs of a recurrence and start treatment (usually casting) before the problem worsens. For your convenience, your family can come to one of our specialty care centers.