Foot

    Clubfoot

    Clubfoot is treated with serial casting using the Ponseti method, percutaneous Achilles tenotomy in most cases and a maintenance brace.

    Medically reviewed: April 2026·Dott. Daniele Priano

    Quick Answers

    Can clubfoot be seen before birth?
    Yes, in many cases it is diagnosed during the second-trimester morphology ultrasound. Prenatal diagnosis does not change prognosis but allows parents to prepare and organize treatment in the very first days of life, when the Ponseti method gives the best results.
    How long does Ponseti method treatment last?
    The corrective phase with casts lasts on average 5-8 weeks (one cast per week). It is usually followed by percutaneous Achilles tenotomy and a final cast for about 3 weeks. The maintenance phase with the Denis Browne brace then begins: it is generally worn for 23 hours a day during the first 3 months, then during sleep until 4-5 years of age, following the treating team's instructions.
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    Clubfoot - Pediatric Orthopaedics Milan Dr. Priano

    Congenital clubfoot (CTEV — congenital talipes equinovarus) is a deformity involving the bones, joints and soft tissues of the foot. The foot is turned inward and downward, with four combined components: equinus, hindfoot varus, forefoot adduction and supination.

    The Ponseti method is the therapeutic gold standard. It uses gentle manipulations followed by serial casts, usually changed weekly, and corrects most clubfeet without extensive surgery. Percutaneous Achilles tenotomy is a surgical procedure within the Ponseti pathway and is required in most cases to correct residual equinus.

    After correction, maintenance with a Denis Browne foot-abduction brace is essential: it is generally worn for 23 hours a day during the first 3 months, then during sleep until 4–5 years of age, according to the treating team's instructions. Adherence to the brace is the most important modifiable factor in reducing recurrence risk.

    Dott. Daniele Priano - Ortopedico Pediatrico

    ✨The Ponseti Method Works

    Congenital clubfoot, when treated early with the Ponseti method, has excellent results. Serial casting and night bracing allow achieving a functional foot without major surgery in most cases. Early treatment initiation, in the first weeks of life, is crucial.

    Assessment and treatment

    When to seek evaluation

    • Prenatal diagnosis of clubfoot
    • Clubfoot evident at birth
    • Foot deformity in newborn
    • Foot rigidity in equino-varus-adductus-supinatus
    • Follow-up after initial treatment

    What is evaluated

    • Deformity classification (Pirani score)
    • Component reducibility evaluation
    • Exclusion of syndromic forms
    • Monitoring during treatment
    • Long-term result evaluation

    Treatment options

    • Ponseti method: serial manipulations and casts
    • Percutaneous Achilles tendon tenotomy
    • Denis Browne brace for maintenance
    • Tibialis anterior transfer in recurrences
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    When Surgery Is Needed

    The Ponseti method is the gold standard and corrects most clubfeet without major surgery. Some surgical procedures are nevertheless an integral part of the pathway or may be considered for resistant or recurrent deformities.
    🔗View surgical options for this condition →

    Frequently Asked Questions

    Can clubfoot be seen before birth?▼
    Yes, in many cases it is diagnosed during the second-trimester morphology ultrasound. Prenatal diagnosis does not change prognosis but allows parents to prepare and organize treatment in the very first days of life, when the Ponseti method gives the best results.
    How long does Ponseti method treatment last?▼
    The corrective phase with casts lasts on average 5-8 weeks (one cast per week). It is usually followed by percutaneous Achilles tenotomy and a final cast for about 3 weeks. The maintenance phase with the Denis Browne brace then begins: it is generally worn for 23 hours a day during the first 3 months, then during sleep until 4-5 years of age, following the treating team's instructions.
    What happens if my child doesn't wear the brace?▼
    Adherence to the Denis Browne brace is the most important prognostic factor: lack of compliance is the leading cause of recurrence. In published series the risk of recurrence is markedly higher in children who do not wear the brace as instructed than in those who use it regularly. This is why family education and support are integral to treatment.
    Will my child operated on for clubfoot be able to play sports?▼
    Yes. Children correctly treated with the Ponseti method generally achieve excellent function and can play sports normally, even competitively. Slight differences in volume or stiffness compared to the healthy foot may persist, but rarely affect daily or sports activities.

    Important Notice: The information on this page is for educational and informational purposes only and does not constitute medical advice. Each clinical case is unique: the appropriate treatment is determined during the specialist consultation, based on a thorough clinical examination and, where necessary, diagnostic imaging. For any doubts or concerns, please consult a specialist.

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