Foot

Clubfoot

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

Updated: September 2026·Medically reviewed by Dr. Daniele Priano

Quick Answers

Can clubfoot be seen before birth?
Treatment is arranged early, usually during the first weeks of life. It does not have to be completed in the first few days: experienced care and adherence to casting and bracing matter. A later diagnosis still warrants assessment rather than assuming it is too late.
How long does Ponseti method treatment last?
The Ponseti method combines gentle manipulation and serial casting. A small Achilles tenotomy is often needed for residual equinus. After correction, a foot abduction brace is worn for many hours initially and later during sleep and naps, generally until age 4–5 according to the treating team’s programme.
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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: cavus, forefoot adduction, hindfoot varus and equinus.

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. Following the bracing programme reduces relapse risk, although recurrence can still occur with correct use. Discuss fitting or tolerance problems with the treating team.

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?▼
Treatment is arranged early, usually during the first weeks of life. It does not have to be completed in the first few days: experienced care and adherence to casting and bracing matter. A later diagnosis still warrants assessment rather than assuming it is too late.
How long does Ponseti method treatment last?▼
The Ponseti method combines gentle manipulation and serial casting. A small Achilles tenotomy is often needed for residual equinus. After correction, a foot abduction brace is worn for many hours initially and later during sleep and naps, generally until age 4–5 according to the treating team’s programme.
What happens if my child doesn't wear the brace?▼
The brace helps maintain the correction achieved by casting. Following the prescribed programme lowers relapse risk, although recurrence can still occur with correct use. Discuss fitting problems, skin irritation or poor tolerance with the team rather than changing or stopping the device independently.
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.