Ponseti treatment for clubfeet: an international perspective.

PURPOSE OF REVIEW: The purpose of this article is to acquaint the reader with the Ponseti method of clubfoot treatment and to describe the features of the technique that make it superior to other forms of clubfoot treatment. These features make the technique applicable across a wide spectrum of healthcare delivery systems on a truly international basis.

RECENT FINDINGS: The Ponseti method has proven to be successful around the globe, in both industrialized countries and developing nations. In many settings, nonphysician practitioners are primarily responsible for the casting phase of treatment, particularly in areas with a shortage of physicians. Internationally, researchers are effectively expanding the scope of clubfeet treated: older children, postsurgical recurrent deformities, and nonidiopathic clubfeet. The barriers that undermine the outcomes of a Ponseti clubfoot program are primarily poverty and noncompliance with the extended post-casting brace protocol.

SUMMARY: The Ponseti method should be considered the best treatment modality for all children with clubfeet. In the developing world, where most neglected clubfeet occur, emphasis should continue to be the training of practitioners and implementation of programs to reach all affected children. Research will continue to broaden the indications for the method.