Clubfoot (CTEV) Treatment: Ponseti Method and Physiotherapy

Posted on Nov 22, 2025 in Physical Education

What is Clubfoot (CTEV)?

Clubfoot (medically known as Congenital Talipes Equinovarus – CTEV) is a common congenital deformity where the foot appears twisted inward and downward. It is a structural deformity present at birth and may affect one or both feet.

Types of Clubfoot Deformity

1. Idiopathic Clubfoot: The most common type, present at birth with no other associated abnormalities.
2. Neurogenic Clubfoot: Caused by underlying neurological conditions, such as spina bifida or cerebral palsy.
3. Syndromic Clubfoot: Associated with specific genetic syndromes.
4. Postural Clubfoot: Caused by abnormal positioning in the womb; this type is usually flexible and responds well to early treatment.

Key Deformities (Mnemonic: CAVE)

• C – Cavus: An abnormally high arch in the midfoot.
• A – Adductus: The forefoot is curved inward.
• V – Varus: The heel is turned inward.
• E – Equinus: The ankle is pointed downward (plantarflexion).

Treatment Strategies for Clubfoot

The primary goal of treatment is to fully correct the deformity and achieve a functional, pain-free, plantigrade foot.

1. Conservative Management (First-Line)

The Ponseti Method (Gold Standard)

• Gentle manipulation and serial casting performed weekly (typically 4–8 weeks).
• Percutaneous Achilles tenotomy (if required for complete equinus correction).
• Following correction, a foot abduction brace (FAB) is worn to prevent relapse.

French Functional Method (Less Common)

• Involves daily physiotherapy, manipulation, taping, and splinting.

2. Surgical Management

• Surgery is typically reserved for cases where conservative treatment fails or for severe, rigid deformities.
• Procedures may include soft tissue release, tendon lengthening or transfer, and bone procedures (osteotomies) in older children.

3. Physiotherapy Measures in Clubfoot Management

Physiotherapy plays a crucial role before, during, and after the correction phase.

A. Pre-Casting/Manipulation Phase

• Passive Stretching Exercises: To increase the flexibility of the foot structures.
• Manipulation Techniques: Daily stretching of the foot into the corrected position.
• Strapping and Taping: Used to maintain alignment after stretching.
• Parental Education: Instruction on proper handling and home exercises.

B. Post-Correction Phase (Post-Ponseti / Post-Surgery)

Primary Goals of Post-Correction Physiotherapy

• Prevent relapse of the deformity.
• Improve range of motion (ROM).
• Strengthen foot and leg muscles.
• Improve gait and overall function.

Key Physiotherapy Techniques

1. Range of Motion (ROM) Exercises:
   • Gentle dorsiflexion, eversion, and abduction of the foot.
   • Crucially, avoid forceful movements.
2. Strengthening Exercises:
   • Targeting the Tibialis anterior, peroneals, and calf muscles.
   • Utilizing resistance bands or manual resistance (must be age-appropriate).
3. Weight-Bearing Training:
   • Focus on standing and walking activities.
   • Includes balance and proprioception training.
4. Gait Training:
   • Encouraging a normal walking pattern.
   • May involve the use of temporary orthotics if necessary.
5. Functional Activities:
   • Activities such as climbing, walking on varied surfaces, and balance games.
6. Orthotic/Brace Support Management:
   • Supervision and education regarding the Foot Abduction Brace (FAB) wear schedule (e.g., 23 hours/day initially, transitioning to night-time and nap wear up to 4–5 years of age).
7. Parent/Caregiver Education:
   • Detailed instruction on home exercises, brace care, and recognizing signs of relapse.

Summary of Clubfoot Management