Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Influence of Beginning Time of Casting for Clubfoot Treatment by Ponseti Method in Different Age Group Infants: A Retrospective Study

  • 1 Accesses



The clubfoot is one of the commonly found congenital deformities in newborn. The Ponseti method is the most effective nonoperative clubfoot management method. It is based on understanding of pathoanatomy of clubfoot. For classifying severity of clubfoot, Pirani score is used. The number of cast required for clubfoot correction is dependent on its initial Pirani score. This study aimed on how the number of cast for correction of clubfoot deformity depends on starting time of casting and pretreatment Pirani score.

Materials and Methods

This study comprises of 200 patients with 297 affected foot nonoperatively managed with Ponseti technique of casting. We measured initial and final Pirani scores of patients with different age groups.


We found that initial severity was less in 0–1 month age group children but mean casting number was more while initial severity was more in 1–2 month age group, the mean number of casting was less. Tenotomy requirement was also less in 1–2 month age group.


We concluded that casting according to the Ponseti method should be started in 1–2 months age group which shows better results than the other age groups in clubfoot.

This is a preview of subscription content, log in to check access.

Graph 1
Graph 2
Graph 3
Graph 4


  1. 1.

    Iltar, S., Uysal, M., Alemdaroğlu, K. B., Aydoğan, N. H., Kara, T., & Atlıhan, D. (2010). Treatment of clubfoot with the Ponseti method: should we begin casting in the newborn period or later? The Journal of Foot and Ankle Surgery,49, 426–431.

  2. 2.

    Abbas, M., Qureshi, O. A., Jeelani, L. Z., Azam, Q., Khan, A. Q., & Sabir, A. B. (2008). Management of congenital talipes equinovarus by Ponseti technique: a clinical study. Journal of Foot and Ankle Surgery,47(6), 541–545.

  3. 3.

    Ponseti, I. V., & Campos, J. (1972). Observations on pathogenesis and treatment of congenital clubfoot. Clinical Orthopaedics and Related Research,84, 50–60.

  4. 4.

    Dyer, P. J., & Davis, N. (2006). The role of the Pirani scoring system in the management of clubfoot by the Ponseti method. J Bone Joint Surg,88B, 1082–1084.

  5. 5.

    Chu, A., Labar, A. S., Sala, D. A., van Bosse, H. J. P., & Lehman, W. B. (2010). Clubfoot classification: correlation with Ponseti cast treatment. Journal of Pediatric Orthopedics,30, 695–699.

  6. 6.

    Dobbs, M. B., Rudzki, J. R., Purcell, D. B., et al. (2004). Factors predictive of outcome after use of the Ponseti method for the treatment of idiopathic clubfeet. The Journal of Bone and Joint Surgery,86A, 22–27.

  7. 7.

    Scher, D. M., Feldman, D. S., van Bosse, H. J., Sala, D. A., & Lehman, W. B. (2004). Predicting the need for tenotomy in the Ponseti method for correction of clubfeet. Journal of Pediatric Orthopedics,24, 349–352.

  8. 8.

    Haft, G. F., Walker, C. G., & Crawford, H. A. (2007). Early clubfoot recurrence after use of the Ponseti method in a New Zealand population. The Journal of Bone and Joint Surgery,89A, 487–493.

  9. 9.

    Dobbs, M. B., & Gurnett, C. A. (2009). Update on clubfoot: etiology and treatment. Clinical Orthopaedics and Related Research,467(5), 1146–1153.

  10. 10.

    Ponseti, I. V. (1992). Treatment of congenital clubfoot. Journal of Bone and Joint Surgery. American Volume,74(3), 448–454.

  11. 11.

    Bor, N., Herzenberg, J. E., & Frick, S. L. (2006). Ponseti management of clubfoot in older infants. Clinical Orthopaedics and Related Research,444, 224–228.

  12. 12.

    Colburn, M., & Williams, M. (2003). Evaluation of the treatment of idiopathic clubfoot by using the Ponseti method. Journal of Foot and Ankle Surgery,42(5), 259–267.

  13. 13.

    Laaveg, S. J., & Ponseti, I. V. (1980). Long-term results of treatment of congenital club foot. Journal of Bone and Joint Surgery. American Volume,62(1), 23–31.

  14. 14.

    Spiegel, D. A., Shrestha, O. P., Sitoula, P., Rajbhandary, T., Bijukachhe, B., & Banskota, A. K. (2009). Ponseti method for untreated idiopathic clubfeet in Nepalese patients from 1 to 6 years of age. Clinical Orthopaedics and Related Research,467(5), 1164–1175.

  15. 15.

    Lourenço, A. F., & Morcuende, J. A. (2007). Correction of neglected idiopathic club foot by the Ponseti method. Journal of Bone and Joint Surgery. British Volume,89, 378–381.

  16. 16.

    Hegazy, M., Nasef, N. M., & Abdel-Ghani, H. (2009). Results of treatment of idiopathic clubfoot in older infants using the Ponseti method: a preliminary report. Journal of Pediatric Orthopedics Part B,18(2), 76–78.

  17. 17.

    Staheli, L, (2003). Clubfoot: Ponseti management. Global-HELP Publication. http://www.scribd.com/doc/76615323/Clubfoot-Ponseti-Management-Editor-Lynn-Stahelli-2003. Accessed 2 Aug 2013.

  18. 18.

    Agarwal, A., & Gupta, N. (2014). Does initial Pirani score and age influence number of Ponseti casts in children? International Orthopaedics (SICOT),38, 569–572.

  19. 19.

    Awang, M., Sulaiman, A. R., Munajat, I., & Fazliq, M. E. (2014). Influence of Age, weight, and pirani score on the number of castings in the early phase of clubfoot treatment using Ponseti method. The Malaysian Journal of Medical Sciences,21(2), 40–43.

  20. 20.

    Lebel, E., Weinberg, E., Berenstein-Weyel, T. M., & Bromiker, R. (2017). Early application of the Ponseti casting technique for clubfoot correction in sick infants at the neonatal intensive care unit. Journal of Pediatric Orthopedics Part B,26(2), 108–111.

Download references



Author information

Correspondence to Mohd Arif.

Ethics declarations

Conflict of interest

There is no conflict of interest.

Ethical standard statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Vaishy, A.K., Arif, M., Acharya, D. et al. Influence of Beginning Time of Casting for Clubfoot Treatment by Ponseti Method in Different Age Group Infants: A Retrospective Study. JOIO 54, 55–59 (2020). https://doi.org/10.1007/s43465-019-00004-6

Download citation


  • Clubfoot
  • Pediatric patient
  • Ponseti method
  • Pirani score
  • Tenotomy