Patient Information The Ponseti technique Author: Trauma and orthopaedics Produced and designed by the communications team Issue date October 2017 - Review date October 2020 Version 3 Ref no. PILCOM1522
What is talipes? Talipes can also be called clubfoot. The medical term for clubfoot in the UK is Congenital Talipes Equinovarus (C.T.E.V). Congenital means that it is present at birth, talipes refers to the foot and ankle itself and equinovarus refers to the foot pointing in an inward and downward position. Talipes is present from birth and causes one or both feet to be curved in and twisted out of the normal position. The calf muscle is commonly less developed on the affected side. It can be diagnosed while you are pregnant during a routine ultrasound scan or after birth. It is more common in boys than girls, and both feet will be affected in 50% of cases. There are other forms or talipes where the foot turns in a different direction but they are less common. The Ponseti technique If your child is diagnosed with talipes the treatment that he/ she will have at Basildon and Thurrock University Hospital NHS is called the Ponseti technique. It is a technique to straighten the feet, which has been successfully used in America for over 60 years. 95% of cases managed using the Ponseti method result in fully functioning, pain free feet. 2
The Ponseti technique is applied in several stages: 1. Casts and gentle specific stretches of your child s foot/feet weekly for approximately four-six weeks. 2. Most children will need a small operation called a tenotomy and a further plaster cast applied (for three weeks). 3. Removable boots and bars to be worn until the child is four-five years old, mainly overnight. This technique aims to correct your child s foot into a strong, functional, normal position that is pain free. When should treatment start? The treatment should be started as soon as possible after your child is born while your baby s feet are still very flexible. Casting and manipulation You will be seen weekly at Basildon and Thurrock University Hospital. Your child will have their foot manipulated by a physiotherapist or orthopaedic surgeon. This manipulation involves gently holding and stretching the foot in a specific way, which moves the bones and gently stretches the tissues within your child s foot. This is done very gradually and 3 gently so it will not hurt your child. They may still complain during the process as they often do not like being handled by strangers or having to stay still. The foot is then held in the new position with a plaster cast. The plaster is applied from the toes to the groin and holds your child s knee bent. The plaster cast is left on for approximately seven days to allow enough time for the muscles and ligaments to relax in the stretched position and for the bones to grow into the corrected position. Once the cast is removed the foot is checked and re-manipulated and a further cast applied. The number of casts your child will have is approximately six, although this can vary depending on the severity of the foot position and tolerance of manipulation.
How can I help during the casting? Warm, wet towels should be wrapped around the plasters to soak them for a few hours prior to arrival in clinic. This will help speed up removal of the casts in clinic as it starts to soften them. Your child should be relaxed during the casting. Bringing their favourite toys, dummy, or feeding them during the process may help. When you re-attend clinic, the plaster will be removed by placing your baby in a bath. They can also be weighed if required. Your baby s foot will then be stretched and a new plaster applied to hold the next position. Once the cast is removed your child s skin may be slightly dry. If you would like to apply a small amount of moisturising cream please bring this with you. Will my child need an operation? Usually yes. The operation is called a tenotomy. Once your child s foot is in a better position, and the foot is able to turn outwards, the tendon at the back of the heel needs to be released as the foot is often still in a pointed position at this stage. Tenotomy Most children will need a tenotomy to aid with the final correction of the foot. This will be performed by the orthopaedic Surgeon, and is a minor procedure. The operation will be performed under a local anaesthetic in outpatient clinic. Your child will have a small cut at the back of their ankle, and the tendon at the back of the foot cut. The operation lasts about one minute. Your child s foot will then be put in the final position and a plaster cast applied to hold this. How long will my child be in plaster? The plaster is removed after three weeks, however, your child will be reviewed at 2 weeks and plaster may be changed then to further stretch the tendon. Next stage Your child s foot will now be fully corrected. As soon as the final plaster cast is removed, your child will be given some special boots that are joined together by a metal bar. The bar holds the feet in their correct position. 4
The splint must be worn for 23 hours a day for the first three months. You can remove the splint for a maximum of one hour, once a day, to bath your baby. A delay in fitting the boots can result in a relapse. After three months your child will only need to wear the boots and bar while asleep (including daytime naps), aiming for 12-14 hours during each 24 hour period. Your child must wear the splint while sleeping until they are fourfive years old. During the day your child can wear regular shoes. The boots and bar maintain the correction long-term. Taking them off for periods can result in a relapse and the need to repeat the plastering stage. Who can I contact if I have any questions? If you have any worries or concerns about the treatment then please contact the physiotherapy department on 01268 593 565. Alternatively the orthopaedic consultant s secretary can be contacted on: 01268 524 900 ext 2741 or 2751. If you need to change or book a clinic appointment the number is: 01268 524 900 ext 2727 or 2728. Plaster cast care and concerns When the plaster is first applied, 5 it can take several hours for the plaster to dry fully. During this time, please take extra care not to disturb the plaster in anyway. 1. Check the circulation It is important to regularly check the circulation of blood to the toes; they should be warm and pink. Gently press the toes, then let go. The toes should turn white and then quickly return to pink. This shows the blood flow is good to the toes. 2. Cast slipping The space between your child s toes and the end of the cast should remain the same. If you cannot see your baby s toes or they seem to be shrinking into the cast, then the cast may have moved. This means the stretch on the foot will not be correct and sore areas can develop on your child s skin. 3. Rubbing Check your baby s skin around the edges of the plaster for any signs of the plaster rubbing, for example, redness. 4. Keep cast dry and clean Change your child s nappy frequently to help prevent soiling the plaster. The casts can be wiped with a slightly damp cloth if they become soiled. If the plaster becomes loose, cracked or crumbles, please contact us.
5. Place casted legs on a pillow The casts can be elevated on a pillow when your child is lying on their back; this reduces pressure on the heels. It is important to contact the hospital immediately if any of the above occurs or you are concerned. Please call the physiotherapist and return with your child to the plaster room, orthopaedic clinic, or accident and emergency department to have the casts checked AS SOON AS POSSIBLE and potentially removed. If you do not comply with all of these instructions, the treatment may be unsuccessful Contact details Children s physiotherapy department: Call 01268 593 565 Plaster room: Call 01268 524 900 and ask for plaster room Useful websites: www.ponseti.info www.nhs.uk www.talipestogether.com www.steps-charity.org.uk www.c-prodirect.co.uk Facebook: Join the Happy Feet talipes group on Facebook. 6
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Not to be photocopied Basildon University Hospital Nethermayne Basildon, Essex SS16 5NL 01268 524900 Minicom 01268 593190 www.basildonandthurrock.nhs.uk Patient Advice and Liaison Service (PALS) 01268 394440 pals@btuh.nhs.uk The Trust will not tolerate aggression, intimidation or violence. This is a smokefree Trust. Smoking is not allowed in any of our hospital buildings or grounds. This information can be provided in a different language or format (e.g. large print, Braille or audio version) on request