Ponseti breeches

The shoes have special side vents to control foot positioning and the front of the shoe is open - the child's toes should also be visible. Since wearing an orthosis during the first phase of treatment takes a long time, namely almost 24 hours a day, with the exception of one hour used for the child's hygiene, the viewing holes in the orthopedic shoes also serve for ventilation.

An orthotic splint is a panacea for clubfoot.

IMPORTANT!!! The only remedy for clubfoot and transverse flatfoot recommended by Oksana Fedorova! Read more.
Congenital clubfoot is a complex orthopedic condition in which the foot is abnormally curved and turned inward. Successful treatment of this condition begins in the first few weeks (7-14 days) of a child's life, and braces play a huge role in this complex process.

• Professional foot orthodontic treatment
• Straightening of the big toe and the joint
• Effective relief from transverse flat feet
• Reduces pain and swelling
• Maintains the natural mobility of the foot (unlike a splint).
• Designed for 24 hour wear

The main advantage of this corrector is that it not only straightens the big toe, but also eliminates the transverse flatfoot. In this way, the ValgoSocks not only fight the bunions, but also its cause.

The Ponseti method

Developed by Ignacio Ponseti, the Ponseti Method is the basis of clubfoot treatment in the 1950s. The orthosis was also invented at that time. The technique consists of alternating steps:

• Bent foot work (kneading, massaging, gradual gentle rotation in the right direction). The stretching of the ligaments should be slight, consistent with their natural elasticity. After five days, the ligaments can be stretched again;
• If the foot position can be slightly straightened, a plaster cast is applied immediately after kneading. The child's leg is placed in a cast above the middle of the thigh in a bent knee position. The doctor decides how long the cast will be in place and when an orthosis will be placed next;

Your child will need to wear a cast for about five days. After this time, the cast is removed and the procedure is repeated. Typically, a cast is applied 6-7 times over a period of 6-8 weeks to fix the foot in its new position. The plaster modeling is carried out with great precision to obtain the final result. The toes are left in the cast to monitor blood circulation in the child's feet;

• If the child's feet have developed normally after the treatment, an orthosis is put on so that the effects last until the child is 3 or 4 years old.

Currently, an orthosis is the only effective way to restore a child's ability to walk and stabilize ankles for life. The orthosis helps to stretch and stabilize the tendons that keep the foot in the correct position, to rotate the foot outward and to fix it. The Ponseti Method has restored many children's ability to move and lead full lives, and the orthosis has played an important role in that.

Standard treatment options for clubfoot

Earlier, before the Ponseti method, clubfoot was corrected with plaster casts and the foot was operated on by lengthening and suturing the tendons of several muscles, severing the ligaments of the foot and opening the ankle. It was not uncommon for the bones of the foot to be involved in the surgery.

The usual method of clubfoot treatment includes the following stages:

• Treatment begins when the child is 1 week old;
• Initially massage sessions (1-2 weeks);
• Plaster casts and paraffin packs alternate for a long time: from a few months to 2 years, depending on the severity of the disease;
• Definitive plaster cast for a period of 5 months;
• If the treatment is ineffective after 2 years, the child undergoes surgery (Z-plasty of the Achilles tendon).

Statistically, the success rate of the standard treatment method is 58 %.

What the Ponseti Method is all about

Ignacio Ponseti was a well-known American orthopedic surgeon who developed a new method of treating clubfoot in the 1950-60s. It is based on a detailed study of the child's foot structure and its pathological changes. Unlike the traditional methods of treatment, this method allows for a fairly quick correction: 1.5-2 months for a full correction, but with a timely start of plaster treatment.

The Ponseti method enables conservative correction of foot deformities, avoiding joint scars and helping to maintain foot and muscle mobility.

The most important condition for the high effectiveness of this technique is an early diagnosis (in the first week of life), when the child's joints and muscles have a high degree of flexibility. Treatment should start at 1-2 weeks of age, always before the child starts to walk.

If the misalignment is only discovered later, treatment using the Ponseti method is also possible, but correcting the error takes much longer.

Principles for fitting an orthosis

Observe the following rules when putting on the orthosis:

• Dress the child in cotton tights or socks of the right size so that there are no extra folds anywhere;
• Unfasten all straps of the orthosis;
• Position the child's foot so that the heel is pressed firmly against the heel and insole of the shoe;
• Fasten the middle strap that adequately secures the foot;
• fasten the other straps;
• make sure there are no wrinkles;
• Attach the shoes to the rail until they snap into place.

In winter, use a warm fur coat when walking or wrap your child's feet in a blanket to avoid skin contact with metal parts.

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Orthopedic braces for children in the range

An orthopedic brace is a world-renowned remedy for clubfoot. It is a shoe that is attached to a special metal rod. The position of the attached shoe can be changed and the angle adjusted according to the doctor's instructions.

The use of this therapeutic tool helps to make a gentle correction and bring the joint into the right position. It is especially practical and effective in childhood, when the musculoskeletal system is growing rapidly and is prone to deformation.

A comfortable Ponseti brace will help your child manage a problem that would otherwise plague them in adulthood and that could cause them a great deal of discomfort.

In the catalog of our online shop you will find both sets of braces and individual pieces. For example, you can order a bridge or shoes separately if required.

Benefits of braces

All of the products we carry are from trusted brands with a long history in the orthopedic industry.

• Simple use. Braces are easy for parents to put on and take off. However, the child himself cannot take them off so easily. The shoes are designed in such a way that the skin of the foot is well ventilated without constricting the foot or restricting blood circulation.
• Quality. Durable materials are used that will last a long time. In this way, the product can be sold quickly after the treatment or if the child's shoes become too small.
• affordability. We supply the orthosis both as a complete set and the individual parts of the set at reasonable prices.

Please note that the type of orthosis, the angle of the foot and the way it is worn must be selected exclusively by your doctor. We are ready to deliver the product to you quickly and offer all the official quality guarantees. To buy an orthosis in Moscow, you can make a request on the site or call the above phone numbers.

Social Protection Departments

Social protection of the Sverdlovsk Region and Yekaterinburg (Resolution of the Government of the Sverdlovsk Region of 04/20/2016. N 273-PP.

Reimbursement of the cost of purchasing prostheses and orthopedic aids for persons without disabilities (except for dental and eye prostheses) (enter such a query with the title in the search engine)

For citizens residing in the Sverdlovsk region (any region, city, municipality, village) who do not have a disability group, but need prostheses and orthopedic aids for medical reasons.

Required documents for compensation (no age limit)

1. Application for OTP compensation (.docx 24.34 KB)
2. Passports of adult family members (original and copy of pages with full name, entry)
3. Medical report confirming the existence of a medical indication for the provision of prostheses and orthopedic aids
4. Receipts of payment for the prosthesis/orthopedic device (receipt, cash and receipts showing the name of the prosthesis/orthopedic device, its type and model and the date of purchase)
5. Child's birth certificate (original and copy)
6. Certificate of residence confirming family composition (valid for 10 days)
7. Certificate of dissolution of marriage, certificate of paternity - for families with only one parent (original and copy)
8. Marriage certificate with different surnames (original and copy)
9. Documents (references) proving the income of each family member for the three calendar months preceding the month in which the application for funding is submitted
10. Consent of adult family members to the processing of personal data
11. Account details of the lending organization
12. SNILS
13. Certificate from the pension fund that you do not have a disability

Gypsum application technique

The Ponseti cast is applied once a week and each cast corrects a specific type of foot deformity. The cast is put on by a doctor, who positions the foot correctly, and a cast assistant.

The cast is placed in the shape of a shoe along the entire length of the foot, leaving only the phalanges exposed to control blood flow and prevent the cast from compressing the blood vessels.

There are some absolute rules that must be strictly followed to avoid medical malpractice:

• The first cast restores the foot's adduction angle and anterior internal rotation (cavus);
• During the plaster cast, the knee joint is fixed in a flexed position to prevent the cast from slipping and to avoid abrasion of the child's sensitive skin;
• The roll-off angle of the foot must be less than 15 degrees in each session;
• When changing the cast, the foot should be in a free position for no more than 1 hour;
• Steps 2-4 aim to correct toe inward deviation (varus deformity) and eliminate sole flexion;
• Step 5 - Allows correction of heel deviation over the talus while the correct foot is immobilized with a bandage by the physician (except in the case of excessive ankle flexion due to tendon shortening).

The number of treatments should not exceed 6. The photo perfectly shows the order and pattern of the corrective casts based on the Ponseti method.

If the doctor does more treatments, this is not an American method and can be harmful. In the following stages, an achillotomy and a fusion are performed.

achillotomy

Treatment according to the Ponseti method includes an achillotomy before the 4th or 5th in some cases:

• Heel tendon ligation (subcutaneous surgery);
• immobilization of the damaged ligament;
• The operation is performed under local anesthesia;
• After the operation, a plaster cast is applied for another 3 weeks.

This operation differs fundamentally from a standard correction operation. The child is not put under general anesthesia and there is no large scar that usually limits the mobility of the foot later.

Why is this intervention necessary?

When walking, the foot rests on the metatarsal bones and on the cusp of the heel bone. The arch of the foot also plays an important role. It cushions the impact of the foot on the ground. It softens the gait and balances the effects of vibration on the spine by evenly distributing the load. This function of the arch of the foot is provided by a complex of ligaments, muscles and cartilage.

If the arch is improperly formed, the child will develop flat feet, clubfeet, and other abnormalities that interfere with normal walking and running. The consequences are diseases of the musculoskeletal system, poor posture, disorders of the nervous system and cardiovascular diseases. Special shoes are therefore essential.

What makes them different from normal shoes

Children need orthopedic shoes to maintain the correct shape of the foot and a strong arch.

Unlike regular shoes, they have the following characteristics:

1. Shoes must correspond to the parameters of the child's foot, taking into account its anatomical structure. The sole is tilted forward.
2. The shoes and slippers should be made of high quality, ecological and durable materials.
3. The sole in the heel area must be stiff. She must securely hold the ankle in the correct position. In the toe area, the shell should be loose and not pinch the toes.
4. Inside the product there must be an orthopedic insole - footbed - made of a material with high water absorption capacity and antibacterial impregnation.
5. Winter shoes should also have stable, non-slip soles so that the child can walk safely on snowy and icy paths.

Shoes that do not meet these requirements lead to a misalignment of the child's foot.

The Ponseti method

The Ponseti method, named after the Spanish doctor who developed it, is used to treat congenital clubfoot. The use of the method is relevant in children, and almost immediately after birth. The optimal age for this treatment is two weeks after birth.

With this manipulation, it is possible not only to correct the deformity, but also to increase the stability of the feet:

The patient's pain is significantly reduced until it disappears completely. After all, with the right approach at the right time, the consequences of this negative state can be completely eliminated.

stages

The Ponseti method works in stages. To this end, it is important to start treatment at the right time. The best time is days 7-14. The condition then depends on the particular disease.

plasters

Casting is the first step in the Ponseti method.

Putting on the cast begins about 1-2 weeks after birth.

The cast is changed weekly to bring the foot from the deformity stage to the correction stage. The reversal angle is about 10-15 degrees in one session.

Important!!! Practice shows that correction occurs after about 5-6 treatments of this type, even if the cases are classified as severe.

Correction of this type is also carried out in stages, depending on the number of dressings. In the first treatment, the most important structures are affected, ie the instep and cavus are corrected, but the foot remains in plantar flexion, ie intact. In the 2nd to 4th treatments, the adduction and varus are gradually changed, ie the foot is also touched.

During the normalization process, the foot is supinated, with the front area being subjected to maximum stress. The head of the talus is fixed. All clubfoot components are corrected in parallel, with the exception of the equinus.

By correct fixation of the talus, the most important clubfoot problems can be corrected as quickly as possible. However, full correction usually occurs only after 5-6 plaster casts.

achillotomy

A closed achillotomy is often necessary, particularly because the Achilles tendon is shortened in congenital clubfoot.

Therefore, it must be prolonged in most children. In the Ponseti method, closed manipulation is suggested as the most gentle and effective.

What is an orthosis?

Clubfoot is one of the most common orthopedic disorders in children. In the treatment of congenital clubfoot, the Ponseti method of gradual correction with plaster casts is often used. Wearing an orthosis is the final stage of this treatment and helps optimize the outcome.

So what is an orthosis?

Orthoses are orthopedic shoes with a plastic or metal splint. This fixation stretches the muscles, prevents clubfoot from reoccurring, and maintains a foot angle of 60 degrees for the corrected foot and 30 degrees for the healthy foot. The splint is worn shoulder-width apart, usually 23 hours a day for the first three months, then 14-16 hours and finally only overnight.

The splint is usually worn until the child is four years old, but some experts extend that to five years. Initially, the child may feel uncomfortable in the orthosis, but there is no reason to stop treatment; over time, the children get used to the orthosis.

Statistically, only 6 of the % children will relapse if the splint is fully adhered to. It is important to understand that the braces do not correct the shape of the foot, but only strengthen the result that has already been achieved.

Different types of corsets

In addition to the orthoses that are used to correct clubfoot, there are other types of braces that are also used in adults:

There are now fixation, correction, pressure relief, functional and combination braces. They can be splinted, stiffened or fitted. They are made of leather, fabric, plastic and a combination of different materials. In addition, they are classified according to their density as rigid, semi-rigid and flexible.

These braces are both mass-produced and custom-made, so that all the characteristics of the patient's leg can be taken into account, whether it is a child or an adult.

The Ortholand Medical Center offers a wide range of orthopedic aids from renowned manufacturers.

manufacturing technique.

The Ponseti plaster technique requires care and attention, as well as compliance with the conditions of fixation. During the rehabilitation period, the orthosis must be worn for a long time in order to consolidate the results obtained. This treatment method is the standard of conservative treatment in Europe and the USA.

The effectiveness of treatment depends on the quality of cooperation between the doctor and the parents. A leg in a cast may inspire pity, but giving in to that feeling can worsen the child's condition and even lead to disability. The orthopedist should strictly follow the dislocation plan and inform parents about changes in the plaster and orthotic regimen.

Correction of the deformity with plaster casts

In this phase, the foot deformity is corrected with plaster casts. Six to seven plaster casts are needed every five to seven days. The foot is brought out of the curvature into a normal position. The angle of limb change is 10-15 degrees at 1 plaster cast. The cast should support the knee joint and cover the upper third of the thigh.

The procedure is carried out by the doctor and his assistant. The nurse holds the limb while the orthopedist applies the cast.

1. The first cast corrects the cavus – the internal rotation of the forefoot. Dorsiflexion in the ankle is restricted.
2. The second to fourth cast corrects the inward rotation of the foot and toes - the varus. In children in the first year of life, the cavus is flexible and mobile. Supination - outward rotation of part of the limb - of the forefoot is required to correct the longitudinal arch of the foot.
3. The deformity is corrected. The talar head remains stationary and the foot is withdrawn. The position of the plate is then stabilized.
4. Four to five plaster casts are sufficient to correct the deformity of the foot. If the foot is difficult to correct, the number of treatments must be increased.
5. There is an improvement with the stretching of the cast changing. However, complete normalization of the cavus, rotation of the foot to a physiological position, varus and partial correction of the equinus is not sufficient. In rare cases of excessive tendon elasticity, correction of the equinus with a cast is possible. In the second stage, surgical correction or an achillotomy is performed.

prognosis of treatment

In 1-2 out of 10 patients there is a relapse, which is due to non-compliance with the wearing of orthopedic structures or the plaster regime. In 90 % cases, after treatment with the Ponseti method, the child can walk at a normal pace and later exercise at the same level as other children.

With a unilateral clubfoot, one foot may be slightly smaller than the other after correction. This does not affect the child's movement, but it can tire more quickly than its peers.

dr EO Komarowski does not comment on this method of treating clubfoot. The orthopedist should deal with the congenital pathology, and the pediatrician should help parents find a clinic that works according to the Ponseti method.

In different countries there are orthopedic societies that should provide a list of doctors and medical institutions upon request of the pediatrician and parents.

Clubfoot correction is a long and gradual daily work of the child, relatives and doctors. And how well everyone is doing depends on whether the child can walk and become a full member of society.

• The Ponseti method.
• 1 year old child with clubfoot.
• Clubfoot in 7-year-old children.
• Congenital clubfoot.
• What is clubfoot?.
• clubfoot.
• Clubfoot in children therapeutic exercises 7 years old.
• Why does a child develop clubfoot?.