Some Frequently Asked Questions.... Page 2
11. How old can a child be and still be successfully treated with the Ponseti Method?  
The Ponseti method is 97% successful if begun within a few weeks of birth.  For a child at 6 months of age, the chances that it will work without surgery drop to about 60%.  For a child changing over to the Ponseti method, the chances depend on the age, severity, and the degree of correction obtained by the prior doctors.  Each case should be looked at individually by a physician, because successful treatment has been reported for children 10 months and older as well as some success in children whose feet had started to regress after having a surgical release.  As always, the key to success after correction is adhering to wearing the brace as prescribed to prevent relapse.  Doctor Ponseti told me that he feels that many cases of relapse could be prevented if the parent had ensured that the child wear the foot abduction brace as he had dictated.
12. What is the debate about x-rays of "corrected" feet? 
The Ponseti method may result in feet with an internal structure where the bones aren't necessarily exactly lined up the way they're supposed to be, and this is one of the reasons Ponseti's method is resisted by many doctors. But the end result is feet which are functional, flexible, pain-free and aesthetically look like feet should look. Regarding x-rays of Ponseti method feet, here is a quote from Dr. Ponseti's article for doctors regarding what he calls a common error of doctors regarding x-ray positioning of bones. Dr. Ponseti says, that it is a common error by doctors to make "Attempts to obtain a perfect anatomical correction. It is wrong to assume that early alignment of the displaced skeletal elements results in a normal anatomy and good long term function of the clubfoot. We found no correlation between the radiographic appearance of the foot and long- term function [3]. In severe clubfoot, complete reduction of the extreme medial displacement of the navicular may not be possible by manipulation. The medial tarsal ligaments cannot be stretched sufficiently to properly position the navicular in front of the head of the talus. Since the joint capsules and ligaments play a crucial role in the kinematics of the tarsal joints [7], they cannot be stripped away with impunity. In infants, the medial ligaments should be gradually stretched as much as they will yield rather than cut, regardless of whether a perfect anatomical reduction is obtained or not [11]." "With a partially reduced navicular, the forefoot can be brought into proper alignment with the hindfoot because the ligaments in front of the navicular and the bifurcate ligaments will yield, allowing lateral displacement and lateral angulation of the cuneiforms and of the cuboid with proper positioning of the metatarsals. The calcaneus can be abducted sufficiently to bring the heel into a normal neutral position. This anatomically imperfect correction will provide good functional and cosmetic results for at least four decades, avoiding many of the complications of operative tarsal release. However, in children more than four or five months old, the ligaments become stiffer and they may need to be divided surgically to adequately position the foot." From what Dr. Ponseti has said, there is the possibility of slight mispositioning of the bones, but in their long term studies, x-rays showing any imperfect positioning did not correlate with any long term problem.  "In a recent review of [the U of Iowa's Ponseti method] patients treated 25 to 42 years ago [3], it was found that although the treated clubfeet were less supple than the normal foot, there was no significant difference in function or performance compared to a population of a similar age born with normal feet."   Another problem would be that when trying to position the bones precisely with surgery, the doctors would have to cut and lengthen tendons and ligaments that deal with the alignment as well as the operation of the joints and to try to reposition and pin joint surfaces that now do not match each other. Then as the foot grows, the scar tissue inside and around the joints affects the future movement and position of the bones of the foot and joints as well. So although with a surgical method, there may be an immediate proper alignment of the foot, it does not necessarily mean that the bones are going to remain in that proper position. This seems to be supported by the fact that with the Ponseti method, in the event of a relapse, surgery involving the bones such as calcaneal, metatarsal or tibial osteotomies are not needed as a part of any treatment. Even if the x-rays may not be totally perfect, the foot will look and function normally for at least 40 years.
Because a few hours without the cast on can allow the foot to start to regress and some of the correction that was just obtained can be lost.
13. Why not remove the cast at home before an appointment? 
14. How frequently are casts changed?
Typically every 5-7 days except for a post tenotomy cast which is left on for 3 weeks to allow the tendon to heal.
15. Where can one go to get more information on clubfoot?
Please see the links page.
16. Are there physicians using the Ponseti Method outside of the United States?
Yes, see the Qualified Physicians list on the U of Iowa Virtual Hospital website, or call for physicians who may not be on the list yet.
17. Where can one get a single pair shoes for different sized feet?
Nordstroms department stores will sell a pair shoes of different sizes at no additional cost.  You may purchase shoes from Nordstroms on-line as well as at their stores.  Some Stride-Rite stores will sell mixed size shoes, check your local store for their policy. 
18. Is a skinny calf common with clubfoot? 
Yes, it is common for the calf of a clubfoot leg to be less developed than a non-clubfoot leg.
19. How were the guidelines established for DBB/FAB use post-correction?  Why not use another device? 
The doctors in Iowa experimented with different types of abduction devices for many years while developing this method.  They found that the current guideline of 3 months of fulltime wear followed by 2-3 years of night and nap-time wear has had the most success in preventing relapses. In the first 10 or so years of the Ponseti method, the rate of relapsing was higher because they had not yet determined what amount of use of the DBB was needed to help prevent it.   About 10-15 years ago, the U of Iowa tried to use AFO's and found that for the Ponseti method, that DBB's worked better to prevent relapses.   With the Ponseti method the DBB's are prescribed for both unilateral and bilateral cases of clubfoot.
20. Will clubfoot slow a child's developmental milestones? 
No.  Clubfoot babies develop at different rates just like non-clubfoot babies.  They'll learn to roll, crawl and walk at their own pace, regardless of the casts and braces!