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The classic: observations on pathogenesis and treatment of congenital clubfoot. 1972.

Ponseti IV, Campos J - Clin. Orthop. Relat. Res. (2009)

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ABSTRACT

This Classic article is a reprint of the original work by Ignacio V. Ponseti and Jeronimo Campos, Observations on Pathogenesis and Treatment of Congenital Clubfoot. An accompanying biographical sketch on Ignacio V. Ponseti, MD, is available at DOI 10.1007/s11999-009-0719-8 and a second Classic article is available at 10.1007/s11999-009-0720-2. This article is ©1972 by Lippincott Williams and Wilkins and is reprinted with permission from Ponseti IV, Campos J. Observations on Pathogenesis and Treatment of Congenital Clubfoot. Clin Orthop Relat Res. 1972;84:50–60.

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(A) Manipulation to correct the right clubfoot of a 6-week-old baby boy. Outward pressure is exerted on the forefoot and counter pressure on the lateral aspect of the head of the talus. The forefoot is never everted; rather, it is displaced laterally as a unit with the midfoot. Heel inversion will correct when the anterior aspect of the os calcis, together with the cuboid and scaphoid, are shifted and turned laterally in relation with the talus. (B) Antero-posterior and lateral views of the toe-to-groin plaster casts used to maintain the corrections obtained by manipulating the left foot of the baby in (A). The plaster casts were changed weekly except for the last one which was left on for 3 weeks. Observe that the forefoot was never everted. No anesthesia was used except to section the heelcords before the application of the fifth plaster cast. The right foot was treated similarly. Well fitting, high-topped shoes attached in 75 degree outward rotation on a 9- inch long steel bar then worn full-time for 3 months, and at night for 6 years.
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Fig4: (A) Manipulation to correct the right clubfoot of a 6-week-old baby boy. Outward pressure is exerted on the forefoot and counter pressure on the lateral aspect of the head of the talus. The forefoot is never everted; rather, it is displaced laterally as a unit with the midfoot. Heel inversion will correct when the anterior aspect of the os calcis, together with the cuboid and scaphoid, are shifted and turned laterally in relation with the talus. (B) Antero-posterior and lateral views of the toe-to-groin plaster casts used to maintain the corrections obtained by manipulating the left foot of the baby in (A). The plaster casts were changed weekly except for the last one which was left on for 3 weeks. Observe that the forefoot was never everted. No anesthesia was used except to section the heelcords before the application of the fifth plaster cast. The right foot was treated similarly. Well fitting, high-topped shoes attached in 75 degree outward rotation on a 9- inch long steel bar then worn full-time for 3 months, and at night for 6 years.

Mentions: Although the clubfoot is in severe supination, the front part of the foot is everted in relation to the heel (the first metatarsal is plantarflexed to a greater degree than the fifth metatarsal) and this relationship causes the cavus deformity [19]. The cavus is corrected by inverting the forefoot (Fig. 3). The navicular, cuneiforms and metatarsals will thus be placed in straight alignment to form the lever arm needed for the correction of heel inversion (Fig. 4A).Fig. 3A–E


The classic: observations on pathogenesis and treatment of congenital clubfoot. 1972.

Ponseti IV, Campos J - Clin. Orthop. Relat. Res. (2009)

(A) Manipulation to correct the right clubfoot of a 6-week-old baby boy. Outward pressure is exerted on the forefoot and counter pressure on the lateral aspect of the head of the talus. The forefoot is never everted; rather, it is displaced laterally as a unit with the midfoot. Heel inversion will correct when the anterior aspect of the os calcis, together with the cuboid and scaphoid, are shifted and turned laterally in relation with the talus. (B) Antero-posterior and lateral views of the toe-to-groin plaster casts used to maintain the corrections obtained by manipulating the left foot of the baby in (A). The plaster casts were changed weekly except for the last one which was left on for 3 weeks. Observe that the forefoot was never everted. No anesthesia was used except to section the heelcords before the application of the fifth plaster cast. The right foot was treated similarly. Well fitting, high-topped shoes attached in 75 degree outward rotation on a 9- inch long steel bar then worn full-time for 3 months, and at night for 6 years.
© Copyright Policy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC2664437&req=5

Fig4: (A) Manipulation to correct the right clubfoot of a 6-week-old baby boy. Outward pressure is exerted on the forefoot and counter pressure on the lateral aspect of the head of the talus. The forefoot is never everted; rather, it is displaced laterally as a unit with the midfoot. Heel inversion will correct when the anterior aspect of the os calcis, together with the cuboid and scaphoid, are shifted and turned laterally in relation with the talus. (B) Antero-posterior and lateral views of the toe-to-groin plaster casts used to maintain the corrections obtained by manipulating the left foot of the baby in (A). The plaster casts were changed weekly except for the last one which was left on for 3 weeks. Observe that the forefoot was never everted. No anesthesia was used except to section the heelcords before the application of the fifth plaster cast. The right foot was treated similarly. Well fitting, high-topped shoes attached in 75 degree outward rotation on a 9- inch long steel bar then worn full-time for 3 months, and at night for 6 years.
Mentions: Although the clubfoot is in severe supination, the front part of the foot is everted in relation to the heel (the first metatarsal is plantarflexed to a greater degree than the fifth metatarsal) and this relationship causes the cavus deformity [19]. The cavus is corrected by inverting the forefoot (Fig. 3). The navicular, cuneiforms and metatarsals will thus be placed in straight alignment to form the lever arm needed for the correction of heel inversion (Fig. 4A).Fig. 3A–E

View Article: PubMed Central - PubMed

ABSTRACT

This Classic article is a reprint of the original work by Ignacio V. Ponseti and Jeronimo Campos, Observations on Pathogenesis and Treatment of Congenital Clubfoot. An accompanying biographical sketch on Ignacio V. Ponseti, MD, is available at DOI 10.1007/s11999-009-0719-8 and a second Classic article is available at 10.1007/s11999-009-0720-2. This article is ©1972 by Lippincott Williams and Wilkins and is reprinted with permission from Ponseti IV, Campos J. Observations on Pathogenesis and Treatment of Congenital Clubfoot. Clin Orthop Relat Res. 1972;84:50–60.

Show MeSH
Related in: MedlinePlus