Specialista in Ortopedia Pediatrica
Clubfoot (post-Ponseti treatment)
Home Exercise Program
Not every exercise listed here is suitable for every child: the selection is individual and is defined during the consultation.
1.Desensitising massage after cast removal
A foot just out of the cast is hypersensitive and must be re-accustomed to touch
During the daily hour out of the brace, massage the foot with moisturiser using varied stimuli: light strokes, tapping, tickling and different textures (cotton ball, sponge, towel). Include dorsum, sole, heel and calf. This reduces skin hypersensitivity and makes the following stretches tolerable.
2-3 minutes at the start of every out-of-brace session
2.Abduction + dorsiflexion stretch (last cast position)
Maintains the correction obtained with Ponseti casts: the key anti-relapse maneuver
Baby supine. One hand supports the leg just above the ankle. The other hand wraps the foot: thumb under the sole, fingers on the dorsum. Move the foot simultaneously OUTWARD (abduction) and UPWARD (dorsiflexion, toes toward the shin), recreating exactly the position of the last cast. Do not lever on the midfoot and do not push on the heel: pressure is applied laterally, on the outer border. If a tenotomy was performed, start only after full healing and specialist clearance.
Hold 20 seconds, 5 reps per foot, at every out-of-brace session
3.Plantarflexion stretch
Restores mobility of the tibialis anterior shortened by months in casts
Place one thumb across the lower leg, just above the ankle, to stabilise it. With the other thumb on the midfoot, push the foot DOWNWARD (plantarflexion, toes pointing away from the shin) until a full toes-down posture is reached. Slow movement, no forcing. This balances the weeks spent in dorsiflexion inside the cast.
Hold 10-15 seconds, 5 reps per foot, at every out-of-brace session
4.Active peroneal stimulation (outer border)
Rebalances strength between the muscles pulling the foot in and out
In clubfoot the muscles pulling the foot in and down are stronger than those pulling it out and up. With the baby awake, stroke the OUTER border of the foot firmly but gently from heel to fifth toe: the foot responds by fanning outward and lifting. Repeat several times, alternating feet, as a game.
10-15 strokes per foot, several times a day
5.Correct brace use and skin check
The brace maintains the correction: exercises never replace it
Follow the prescribed schedule strictly (23 hours a day in the first months, then nights and naps until age 4-5). The heel must always sit fully down in the boot: if the heel rides up, correction is lost. At each change inspect the skin over heel, malleoli and dorsum for persistent redness or blisters. Always use high, seamless socks. Report immediately to the specialist any foot turning inward again.
At every brace application, every day
RED FLAGS - When to stop and contact the doctor immediately
Stop the exercises immediately and contact the specialist (or go to the emergency department if severe) if any of the following occur:
- Acute or sudden pain during exercise
- Significant swelling after exercises
- Pain that progressively worsens over days
- Fever or general malaise
- Difficulty walking or using the limb after exercises
- Any neurological symptoms (tingling, numbness, sudden weakness)
- Fever, redness or warmth of the joint, or inability to bear weight
In case of doubt, always prefer a check-up over continuing the exercises.
Dott. Daniele Priano
Ortopedia Pediatrica - ASST Gaetano Pini-CTO
ortopediaevolutiva.com • 26/08/2026
Versione Web
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MioDottoreBefore You Start
Who is this guide for?
Infants with clubfoot, undergoing Ponseti treatment. Mobilizations to maintain achieved correction.
What you need
Clear floor space, mat or soft surface, comfortable clothing. Some exercises may require resistance bands or supports.
Suggested frequency
Usually 1-2 times daily, as directed during the visit. Consistency is more important than intensity.
Common mistakes to avoid
- •Not performing mobilizations regularly
- •Not having child wear brace as directed
- •Discontinuing night brace too early
⚠️ Red flags — when to stop and contact the doctor immediately
Stop exercises immediately and contact the specialist if any of the following occur:
- Acute or sudden pain during exercise
- Significant swelling after exercises
- Pain that progressively worsens over days
- Fever or general malaise
- Difficulty walking or using the limb after exercises
- Any neurological symptoms (tingling, numbness, sudden weakness)
Detailed Exercises
- 1
Desensitising massage after cast removal
A foot just out of the cast is hypersensitive and must be re-accustomed to touch
During the daily hour out of the brace, massage the foot with moisturiser using varied stimuli: light strokes, tapping, tickling and different textures (cotton ball, sponge, towel). Include dorsum, sole, heel and calf. This reduces skin hypersensitivity and makes the following stretches tolerable.
2-3 minutes at the start of every out-of-brace session - 2
Abduction + dorsiflexion stretch (last cast position)
Maintains the correction obtained with Ponseti casts: the key anti-relapse maneuver
Baby supine. One hand supports the leg just above the ankle. The other hand wraps the foot: thumb under the sole, fingers on the dorsum. Move the foot simultaneously OUTWARD (abduction) and UPWARD (dorsiflexion, toes toward the shin), recreating exactly the position of the last cast. Do not lever on the midfoot and do not push on the heel: pressure is applied laterally, on the outer border. If a tenotomy was performed, start only after full healing and specialist clearance.
Hold 20 seconds, 5 reps per foot, at every out-of-brace session - 3
Plantarflexion stretch
Restores mobility of the tibialis anterior shortened by months in casts
Place one thumb across the lower leg, just above the ankle, to stabilise it. With the other thumb on the midfoot, push the foot DOWNWARD (plantarflexion, toes pointing away from the shin) until a full toes-down posture is reached. Slow movement, no forcing. This balances the weeks spent in dorsiflexion inside the cast.
Hold 10-15 seconds, 5 reps per foot, at every out-of-brace session - 4
Active peroneal stimulation (outer border)
Rebalances strength between the muscles pulling the foot in and out
In clubfoot the muscles pulling the foot in and down are stronger than those pulling it out and up. With the baby awake, stroke the OUTER border of the foot firmly but gently from heel to fifth toe: the foot responds by fanning outward and lifting. Repeat several times, alternating feet, as a game.
10-15 strokes per foot, several times a day - 5
Correct brace use and skin check
The brace maintains the correction: exercises never replace it
Follow the prescribed schedule strictly (23 hours a day in the first months, then nights and naps until age 4-5). The heel must always sit fully down in the boot: if the heel rides up, correction is lost. At each change inspect the skin over heel, malleoli and dorsum for persistent redness or blisters. Always use high, seamless socks. Report immediately to the specialist any foot turning inward again.
At every brace application, every day
Frequently Asked Questions
How long should I do clubfoot mobilizations?
Mobilizations should be performed throughout the bracing period (generally until age 4-5) and ideally continued beyond. Consistency is essential to maintain the correction achieved with Ponseti casts.
Can I hurt the baby with mobilizations?
If performed correctly and gently, mobilizations are safe and beneficial. The key is to NEVER force: movements should be gentle and the baby should not cry from pain. If in doubt, ask the specialist for a demonstration.
Can mobilizations replace the brace?
No, mobilizations do NOT replace the brace. They are complementary and should be performed in addition to correct brace use as directed by the specialist. The brace maintains correction, mobilizations maintain flexibility.