Clubfoot, or congenital talipes equinovarus (CTEV) in medical terms, is one of the most common congenital musculoskeletal deformities, affecting around 1 in 800 live births in India.
Clubfoot is a complex deformity and consists of cavus, forefoot adduction, heel varus, and equinus. If not treated early and adequately, it may lead to long-term disability, social stigma, and significant financial burden.
Fortunately, the Ponseti method has changed clubfoot management, allowing a low-cost intervention with a high impact on paediatric orthopaedic care throughout the country.
As a practicing paediatric orthopaedic surgeon working in India, I manage many infants and young children with clubfoot each year. The Ponseti method has been the global gold standard for clubfoot management for the last 20 years.
This is a gentle, nonoperative method that utilizes the flexibility of the infant's foot and a detailed understanding of developmental anatomy. The Ponseti method involves weekly gentle manipulation of the foot followed by a long-leg cast application to correct the deformity in a planned order.
The number of casts needed is typically between 5 and 8, and a small outpatient / daycare procedure called percutaneous Achilles tenotomy is performed to correct the equinus deformity.
This is an essential manoeuvre to achieve good dorsiflexion at the ankle. Subsequently, a foot abduction brace must be used for a defined period to prevent recurrence.
In India's resource constrained environment, the relative socio-economic advantages of the Ponseti method is palpable. It is a low-cost intervention, requiring minimal surgical facilities, and achieves very high success rates (greater than 90%).
In terms of direct and indirect health care costs, Ponseti is much cheaper than older methods of management, which necessitate hospitalization and long periods of recovery. It circumvents the need for extensive corrective surgery which was the former standard of procedures, often resulting in stiffness and long-term complications.
In fact, now we have been treating even the older children with neglected and relapsed clubfoot also, very successfully using ponseti technique. From a public health perspective, early management of clubfoot avoids permanent disability later in life which not only allows a child in school, in social life, but leads him into the effective workforce.
For many families, particularly from rural or poorer communities, this can make the difference between a dependent disabled life for their child or self-sufficiency.
In my own practice, I have treated children from below the poverty line who regained mobility and dignity, walking confidently into schools and day to day life. It is no exaggeration that this method has transformed the field of paediatric orthopaedic surgery, embracing children with clubfoot.