Clubfoot: Ponseti Method

Rubin Orthopedics specializes in treating clubfoot. We begin treatment immediately after birth, using the Ponseti Method. This involves 6 sets of casts which are changed weekly. After the sixth cast an Achilles release is typically performed and the baby is placed in another cast, this one usually for three weeks. Then the baby is placed in special shoes with a bar between the shoes, which is worn for three months full time and then at night until the child is 3 or 4 years old.

We have treated many babies with clubfoot and the treatment has been very successful. The children go on to lead normal lives. It is very satisfying for us to treat these children since the treatment so dramatically improves their lives.

We also provide prenatal consults to mothers who have found out that their unborn child has one or both clubfeet based on an ultrasound examination performed by their ob/gyn doctor. In this consultation, we explain the prognosis and treatment of the baby after birth. We invite the mother to watch the process of casting and speak with other mothers in our practice whose babies have been treated for clubfoot. --Roy M. Rubin, M.D.

Dr. Rubin casting a baby with clubfeet.	Dr. Rubin and Mike casting a baby with clubfeet.
Photo of clubfoot (right foot) after the Achilles Release.	Photo of clubfoot (left foot) after the Achilles Release.
A clubfeet baby 2 years later and wearing Dennis Brown Bar shoes.	This is the same child showing excellent range of motion.
Five month old baby who is being treated for Left Clubfoot. He had an Achilles Release when he was 2 months old. He is currently wearing the Dennis Brown shoes twelve hours every night.	This is the same baby out of the Dennis Brown Shoes.
She is almost 2 years old and has been treated by Dr. Rubin for bilateral clubfeet. She is wearing the Mitchell Brace twelve hours every night and is doing great.	A 2 1/2 year old who has been treated since birth for bilateral clubfeet is now using the Mitchell Brace twelve hours a day. His mom taught him to snap the bar himself, which makes it fun for him to put the brace on before he sleeps at night.

For more information on the Ponseti Method please visit the Hospital for Special Surgery website.

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Injuries to the toes and fingers are common, and we treat a lot of these conditions in our office. Sports, home accidents, power tools, work benches, car doors, and heavy furniture all can cause injuries to the nail. Shoes can be protective for the toes, but often times we do not wear boots or shoes for convenience sake.

Nails grow along the nail bed. New nails are manufactured from the germinal layer. If the germinal layer is damaged, the nail will not grow. If the nail bed itself is torn or lacerated, the nail will not grow beyond the laceration. It is therefore very important to recognize when a laceration to the nail bed has occurred. A high index of suspicion is required.

A cut through the nail itself suggests a laceration. Fractures to the distal tufts of the fingers or toe are often times associated with a nail bed laceration. The more displaced the fracture, the more likely the nail bed has been damaged. The presence of blood underneath the nail is also strongly suggestive of nail bed laceration.

Dr. Paul Lesko, M.D.