Re: Ponseti Method for clubfoot
I am a podiatry student doing a clinical placement in a rural area which also services small remote commuities. While attending a clinic in a remote community we assessed a 2 year old aboriginal boy who had been referred to podaitry by a physiotherapist with ? R) talipes equinovarus. On assessment there was a classical looking talipes equinovarus with the exception that the we could dorsiflex his ankle to the point that his toes could touch his anterior leg. We also were unable to palpate or see any sign of an achilles tendon and he severe atropy / under-development of his R) gastrocnemius / soleus muscles. Other than this he is healthy and running around the room (albeit on the lateral / dorsal aspect of his right foot) with no apparent signs of pain or discomfort.
He had been assessed by a visiting paediatrician in late 2008 & in December 2008 travelled to a tertiary paediatric hospital where he was assessed by an orthopedic surgeon with a diagnosis of ? talipes ? tibialis anterior weakness. He was sent back to his remote community for conservative care (which appears to mean do nothing) & have an orthopedic review at the tertiary facility in December 2009.
My question is should this child have been casted & then put in shoe braces (Ponsetti Method) or is it appropriate to do nothing and wait and see as has been done in this case? I appreciate that there may have been some compliance issues in this case, but I think they could have been adequately addressed in the community. I would be interested to hear from anybody who has had experience in managing talipes.