The principles of the Ponseti method in the treatment of congenital clubfoot.

We present Ignatio Ponseti's approach to idiopathic clubfoot management and its biological basis. The key principles of the Ponseti method of treatment are 1. All deformity components are corrected simultaneously except equinus, which is corrected last, usually by percutaneous Achilles tenotomy. 2. The correction is maintained by external foot rotation around the head of the talus. 3. The excavatus is corrected by supination of the first ray of the foot. 4. The corrections are performed weekly and after 4-5 weeks of treatment a percutaneous Achilles tenotomy is performed in local or general anaesthesia. 5. After another 3 weeks of plaster cast immobilisation, a Dennis Brown brace is used to keep the correction until 4-5 years of life.