Parents of Older Children
For many years, many Ponseti trained doctors were unsure about the effectiveness of the Ponseti Method for treatment of children 2 and older. However, recent research has shown that this method can be effective for children with neglected clubfoot and children who have had failed surgery. The oldest child successfully treated with the Ponseti method for failed surgery was 10 at the time of treatment. Ponseti trained doctors have now treated dozens of older children. Listed below are some modifications of the Ponseti method for older children as well as other information to be aware of.
- According to research done by several Ponseti trained physicians the average number of casts for older children is about 10. The doctor should also spend more time manipulating the foot during visits (about five to ten minutes) to allow for greater stretching of the soft tissue. Each cast needs to be worn for a longer period (about two weeks) than for younger children. Because there will be some side effects of long periods of casting, it is advisable to allow the child to walk on the cast and also in each visit to the clinic after the cast is removed. This will reduce stiffness and muscle atrophy.
- The doctor will also correct the foot to 30 to 40 degrees abduction (30 to 40 degrees away from the midline of the body) as opposed to 70 degrees for younger children. This does not limit the effectiveness of the Ponseti Method for treatment of older children.
- After treatment, all children need to wear a brace to prevent relapses. A brace is kind of like a retainer for your foot; it keeps the foot from turning back inward. In general, it is used as in younger kids until the age of 4 years. After that age, some doctors will recommend a muscle transfer to balance the foot, therefore, allowing not using the brace.
- Physical therapy is a very important tool used to help older children maintain correction as it helps improve muscle strength. Ask your doctor about where to find physical therapists in your area.