Club Foot is one of the most common congenital deformities in babies and children. Feet grow a lot, and very quickly in the first years of life. Therefore, treatment with the Ponseti Casting Method begins approximately 1-2 weeks after the baby is born. The timing is very important because a baby’s ligaments and tendons are elastic and easily moved at this stage of development. The Ponseti Casting Method uses a series of casting, stretching and bracing methods to correct the deformity without causing pain or discomfort to your baby.

Indications / Candidacy

The Ponseti Casting Method is used to treat Clubfoot deformity, otherwise known as Congenital Talipes Equino Varus (CTEV). This common condition may affect one or both feet in a newborn baby. At birth, babies with Clubfoot deformity present with feet twisted inward as a result of leg tendons being shorter than usual.

Good Candidates for this procedure may experience the following:

  • Feet that point down and turn in
  • Diagnosed Clubfoot deformity

Treated Conditions

The Canadian Limb Lengthening Center offers treatment of many complex orthopedic conditions. We pride ourselves in providing highly specialized expert care and a holistic approach. The Ponseti Casting Method is just one of the advanced techniques we use to correct deformity in our pediatric patients. We also use other casting techniques to correct other pediatric foot deformities such as :


Clubfoot deformity

Surgical Technique

The Ponseti Method involves two phases:

  1. The casting phase, which gradually moves the foot to the correct position
  2. The bracing phase, which makes sure it stays in the correct position


  1. Starts when a baby is 1-2 weeks old
  2. The surgeon will do soft tissue massage and stretches with the baby’s foot for a few minutes before putting a cast on to hold the new position.
  3. The baby will wear a series of 5 to 7 casts over a few weeks or months. Undergoing movements and stretching before each new cast is set to gradually correct the deformity more and more with each cast.
  4. Each new cast will turn the baby’s foot a bit more in the correct direction.
  5. About 80-90% of the time, at the final casting a small procedure or surgery is required. The procedure involves cutting of the heel cord tendon is through a small incision, under local anasthesia or in the operating room.
  6. Once the tendon is cut, a final cast is applied for a few weeks.
  7. When the foot is in its final, correct position, the bracing phase begins.


  1. When a baby’s foot has been moved into its final, correct position from the casts and stretches, a brace will be fitted.
  2. The brace usually consists of a bar with shoes or boots at each end.
  3. It keeps the foot from twisting back to where it was before the casting.
  4. A child will wear the brace all the time for about 3 months, and then only at night and during naps for 2-3 years (until age 4-5) or as directed by your surgeon.
  5. Without the brace to keep a corrected clubfoot in the proper place, the rapid growth that occurs at this stage of the child’s development would send the foot back into the clubfoot position.


The Ponseti method is successful for most kids with Clubfoot deformity, and will allow them to walk, run, and play without pain. In general, the expected success rate of the Ponseti Method in babies without other health issues is 95%. By the end of treatment all elements of Clubfoot Deformity will be reduce if not eliminated. Obtaining a functional, flexible, pain free, strong, and normal looking foot brings our patients better quality of life during both childhood and adulthood. Successful results depend on many factors including the severity of Clubfoot, involvement of other health issues, cooperation of the parents, and brace compliance.

Potential Complications

As with any medical treatment, The Ponseti Casting Method and other casting techniques can have difficulties and complications. Through education, our team of experts will educate parents on complications and symptoms to be aware of during casting and bracing phases. At the Canadian Limb Lengthening Centre we are well equipped to treat complications should they arise. These may include:

  • Cast loosening
  • Cast-associated skin irritation or pressure sores
  • Recurrence of deformity

Pre-Operative Care

  • Use a calendar or agenda to organize your infant’s appointment dates
  • Plan to assist your child throughout the entire casting and bracing process
  • For infants, often bringing a bottle to feed during treatment can help keep them calm
  • For older children, a favorite toy or electronic device will help keep them distracted
  • Prepare to have regular appointments for the first 4 -5 years after casting

Post-Operative Care

  • During casting phase, watch for signs and symptoms of complications such as skin infection and poor circulation
  • During bracing phase, ensure sure the skin is clean and very dry before putting the brace on
  • Put the brace on by first fitting the most difficult foot . Gently flex the foot and then push the heel into the brace.
  • Compliance with wearing the brace is of the upmost importance and needs to be incorporated into the child’s routine.

Follow-ups after surgery

  • During the casting phase the baby will go to the orthopedic surgeon about once a week for gentle moving and stretching of the foot, followed by placement of a new cast
  • Once the casting phase is complete, a follow up appointment will be scheduled to size and order the brace
  • After full correction kids will see their specialist for regular follow-up visits every 3 -4 months up to age 5
  • After age 5 an annual follow up is made until child is done growing (around age 18)

Case studies

2 week old baby boy with Bilateral clubfeet


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Highly specialized expert care at CLLC

At the Canadian Limb Lengthening Centre we offer complex deformity correction and limb lengthening surgeries performed by experienced surgeons with the most up to date technologies. When it comes to your care, and treatment of deformity and limb length discrepancy, our surgeons have extensive training and experience.