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Article Category: Highlights

Clubfoot & The Ponseti Method

Published on February 11, 2025

Last updated 03:16 PM February 11, 2025

Illustration of provider treating child with clubfoot

When a health condition affects your child’s quality of life or keeps them from doing what they love, your family can rely on Wellstar Pediatric Orthopedics to provide compassionate, comprehensive care. As your child grows, so do their bones and joints, and they need specialized expertise—whether they have broken a bone on the playground or have an orthopedic condition present at birth.

Approximately one to four of every 1,000 babies are born with clubfoot, a condition in which one or both feet are turned inward and downward. The deformity affects a baby’s bones, muscles, tendons and blood vessels. Fifty percent of children born with clubfoot have bilateral clubfoot, which means both feet are affected. While the condition is readily visible at birth, many times the deformity is detected on prenatal ultrasounds, allowing weeks or months for the parents to prepare for the expected treatment. Most children born with clubfoot do not have a parent with the condition. Risk factors include male biological sex (boys are born with clubfoot twice as often as girls), genetic syndromes, neuromuscular disorders, birth defects and a breach birth.

Clubfoot is not a painful deformity, and most children who are treated early go on to live active and healthy lives. However, untreated clubfoot will not improve on its own. As the child gets older, they will have a challenging time walking on their own.

Our team of experts understands that babies born with clubfoot may also have associated conditions such as hip dysplasia or torticollis. Therefore, we thoroughly examine your child to ensure all their needs are addressed.

There are two types of clubfoot: idiopathic and syndromic. Idiopathic clubfoot is the most common, and although we suspect there is a genetic component, we still do not know what causes it. Idiopathic clubfoot is not related to any other medical issues. Alternatively, syndromic clubfoot is more severe, difficult to treat and occurs as part of a larger medical condition. If your child is diagnosed with syndromic clubfoot, our team will coordinate with multiple specialists to tailor care to your child’s specific needs.

Treatment for clubfoot usually begins when the child is a few weeks old. The goal is to correct the foot position before they learn to walk, thus minimizing the impact of the condition on the child’s long-term mobility. This is done through a series of casts designed to help the foot grow more normally.

“We use the Ponseti method, a nonsurgical approach that uses a series of casts and then bracing to gradually reposition the foot,” said Wellstar Pediatric Orthopedic Surgeon Dr. Michael Priola.

With this method, the doctor stretches out and repositions your child’s foot, then places it into a long leg cast to hold their foot in the appropriate position. Long leg casts are used to prevent the cast from slipping off the child’s leg. The cast is removed in about a week, the doctor again repositions the foot, and a new long leg cast is placed. This method continues until your child’s foot is moved into the correct position. Many of our providers utilize soft cast material, which has a higher parent satisfaction rating than the typical plaster material. Following casting, about 90% of patients require a minor procedure that releases the Achilles tendon, allowing further correction of the foot deformity. A final cast is then worn for an additional three weeks before being removed in the clinic.

Once corrected, a brace is used to maintain the alignment over several years. For the first three months after completion of the casting, the brace is worn for about 22 to 23 hours per day. After that, children typically progress to wearing the brace for naps and nighttime only (about 15 to 16 hours per day). This allows your child to learn to crawl, walk, run and play in the normal developmental time frame. Families should continue with this bracing schedule until the patient is 4 years old to prevent the condition from returning.

“This method boasts a high success rate and avoids the need for extensive surgery,” Dr. Priola said. “Sometimes in more severe cases (including a rigid clubfoot) or if the Ponseti method fails, more extensive surgical intervention may be considered.” These surgeries include a complete posteromedial release of soft tissues, tendon lengthening and realignment of joints.

With timely and appropriate treatment, children born with clubfoot can experience significant improvement, leading to a bright future that is not limited by the condition.

If your child is affected by clubfoot, our pediatric orthopedic specialists are here to provide expert care for this condition and support them at every step of treatment. We understand that medical procedures can be stressful for both children and their families. Your child’s care team will personalize treatment to their individual needs and answer any questions you have about clubfoot or managing the condition.

To book an appointment with a pediatric orthopedic surgeon, visit wellstar.org/pedsortho or call (404) 321-9900.

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Michael Priola Bone and Joint Care
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A friendly image of Limb Lengthening

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Limb Lengthening and Deformity Correction

The history of orthopedic surgery is mankind’s attempt to make straight that which is crooked. The advent of anesthesia made it possible to use surgery to break bones and re-align them without undue pain. But the art of correcting deformities caused by abnormal growth or trauma has taken hundreds of years to advance to its current form. The most important observation—made incidentally by multiple surgeons, but most famously by Gavrill Ilizarov during the 1950s in the Soviet Union—was that a broken bone, if pulled apart with appropriate timing and stress, can form new bone.

This discovery came with years of painstaking research and trial and error in order to effect techniques that would allow for gradual correction of limbs that were bent, short or otherwise deformed. Initially, external fixator apparatus were used to manually manipulate the bone with daily turns of a crank, which involved mathematical calculations and equations that lacked precision when applied to the individual case. Gradually, these methods evolved to incorporate automation, modern computing and more biologically friendly surgical techniques. Newer devices allowed for the distraction pressure to be applied inside the body rather than outside in select cases, making the process of correcting limb alignment problems less cumbersome to patients.

Limb lengthening and deformity correction has always been a powerful yet technically difficult procedure, making it a smaller and less-utilized area of orthopedics. But the ability to correct errors of genetics or nutrition or deformities from trauma or infection is nothing short of magical—and magic requires study, practice and dedication to perform correctly. Distraction osteogenesis techniques are often applied to problems that are intractable by other, more commonplace means. Practitioners of the art enjoy the unique challenges presented and the potential to affect patients’ lives for the better. It is not always easy or simple, but the reward of helping others is the driving force behind the effort.

Subspecialty training in the area of limb lengthening and deformity correction is now available in the United States at several centers. A subspecialty society, the Limb Lengthening and Reconstructive Society (LLRS) provides educational opportunities with meetings and traveling fellowships. Orthopedic surgeons who have taken advantage of the society’s training and membership are often those most committed to learning the art and science of limb deformity correction. The Orthopedic Trauma team at Wellstar Kennestone Regional Medical Center includes physicians who have undergone this training and enjoy being a resource for patients and the orthopedic surgery community at large when it comes to limb deformities, difficult malunions or nonunions, infections requiring bone transport and other complicated cases. At Wellstar, modern techniques using both external fixation and computer-assisted guidance allow limb deformity correction to occur with minimal patient discomfort or manipulation of complex apparatus. Internal techniques are also used, including lengthening nails that allow the limb to be lengthened or straightened, replacing the need for a cumbersome external fixator.

Complications from orthopedic surgery often require unique solutions. Infected joint replacements, infected bone that requires removal (osteomyelitis) and bone loss resulting from severe trauma are all conditions that can be treated with modern limb lengthening and deformity correction techniques. The physicians specializing in these techniques are happy to consult over the phone with other physicians who need assistance in these complex situations, as well as share their expertise with patients during in-person consultations. The desire to provide world-class healthcare defines the individuals who make up the Orthopedic Trauma division at Wellstar. There are few orthopedic problems that they are not eager to try to solve, and they are always willing to learn the newest techniques in order to improve the lives of those who believed their cause was lost.

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Illustration of doctor showing imaging of spine to parent and child

Highlights

Wellstar Pediatric Orthopedics Provides Advanced Scoliosis Care for Children

Scoliosis, or curving of the spine, has been around for centuries. Over time, treatments have improved to offer patients more options to maintain motion and recover smoothly. The compassionate experts at Wellstar Pediatric Orthopedics use cutting-edge technology to provide scoliosis care tailored to your child.

Fusion, which involves bone grafting and limiting motion through segments to control spinal deformity, used to be a popular treatment method. However, these treatments could lead to stiffness and postoperative pain concerns.

“As care has evolved, clinicians have begun to focus on alternative methods that help patients maintain motion and flexibility,” said Wellstar Pediatric Orthopedic Surgeon Dr. Timothy Oswald.

Over the last two decades, an immense amount of research and innovation has led to the development of new procedures to preserve motion, called fusionless scoliosis treatments. Currently the two most popular and well-studied treatments are anterior vertebral tethering and posterior distraction technologies. 

Vertebral body tethering

Vertebral body tethering is an improvement upon previous treatment and allows for the potential of improved correction. However, the procedure has also now been associated with a high incidence of tether breakage and progression.

In this procedure, the surgeon attaches metal anchors to the side of the spine that is curved. A flexible cord is connected to these anchors, and as the child grows, the tether slows the growth on the curved side, helping the spine grow straighter. 

Currently there are very limited indications and a very specific time frame when tethers have been found to be successful for improving curves in the growing child. But as with any new technology, the next generation of innovation is encouraging: The tethers have become stronger and indications clearer. Wellstar currently offers this treatment but with very strict inclusion criteria so that we can have the best outcomes for our patients.

Posterior distraction technologies

Another new option is posterior distraction based fusionless technologies. The surgeon implants a rod with flexible joints that help the patient maintain normal spine motion.This procedure has shown an 85% success rate within two years with controlling the curve of the spine, but there are still concerns of instrumentation failure and progression. Wellstar also offers this surgery and has had good success in the appropriate patient population.

If your child has advanced scoliosis, Wellstar offers multiple care options, and our team is experienced in treating this condition in children. Our specialty surgeons each have over 20 years of experience treating pediatric spinal deformities. To find a surgeon near you, visit wellstar.org/pedsortho. 

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People playing pickleball

Highlights

Orthopedic Advice for the Weekend Warrior

By Dr. D. Hodari Brooks, Wellstar orthopedic surgeon

As a board-certified orthopedic surgeon, I treat hundreds of patients a year who have injured themselves while exercising on the weekend. Typically, this involves activities such as pickleball, tennis, soccer, golf and running. While these activities can promote improved muscle strength, joint health and cardiovascular benefits, when they are not done correctly, orthopedic injuries can result. Some of the more common injuries include:

Ankle injuries

Achilles injuries are some of the most common injuries I treat. Often, they result from improper stretching and warm-up prior to physical activity. When the Achilles is torn, surgical repair is often, but not always, necessary. Ankle sprains are also very common and usually much less severe than Achilles tears. These injuries typically result from rolling your ankle awkwardly when jumping or running. Rest, ice, elevation and compression with a bandage or brace is an effective treatment.

To help prevent these injuries, focus on a good stretching routine for at least 10 to 15 minutes before engaging in physical activity. Proper shoes can also help, and be mindful of where you step.  

Knee injuries

Meniscal tears are one of the more common knee injuries. The meniscus is a circular disc-like cartilage located in the knee. When a twisting or torsional injury occurs, the meniscus can get torn. This can produce catching or locking type symptoms and may require surgical treatment. Injuries to the patellar tendon or quadriceps tendon are also somewhat common and usually result from a failure to stretch and warm up appropriately. Whenever the patellar or quadriceps tendon is torn, surgery is almost always required.  

Focus again on stretching prior to activity. When the activity is relatively strenuous, such as pickleball, tennis or basketball, then you should build up a quadriceps strengthening program and core strengthening prior to engaging in activity.

Shoulder injuries

Rotator cuff injuries are very common and can range from strains to complete tears. Injuries occur when people fall on an outstretched hand, like diving for a ball, or through other twisting motions. When the rotator cuff is strained but not torn, physical therapy will usually suffice. However, when torn, surgical treatment may be necessary.  

The best way to prevent shoulder injuries is to focus on stretching prior to activity and to engage in a strengthening program.  

I encourage you to engage in physical activity, but attention to stretching, strengthening and focusing on your environment can help you avoid a variety of orthopedic injuries.  

Learn more about orthopedic care at Wellstar at wellstar.org/ortho.

Photo of Dr. D. Hodari Brooks, Wellstar orthopedic surgeon

Dr. D. Hodari Brooks, Wellstar orthopedic surgeon

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