Ponseti therapy is a systematic approach to treat clubfoot, usually consisting of the following steps: first manual correction, then a cast fixed in the maximum corrected position, usually 5 casts to correct the clubfoot and high arches; in almost all cases, a percutaneous Achilles tendonotomy to completely correct the clubfoot; then a final cast and 3 weeks of maintenance; and then nighttime wear of a foot abduction The nighttime support is usually needed until the child is 2 to 4 years old. Indications: 1, simple clubfoot, infants start treatment before 9 months of age, the best results, if started between 9-28 months of age, can still correct all or most deformities; 2, rigid clubfoot, congenital joint deformity, spina bifida, Larsen syndrome can be applied Pansetti method. Although the treatment effect is not as good as the effect of simple horseshoe foot, but still can play its superiority; 3, spinal cord dysplasia horseshoe foot; 4, complex horseshoe foot, horseshoe foot patients once to inexperienced doctors for manipulation and plaster correction, even if not cured, and then use the Pansetti method, the patient may still be cured through treatment. Procedure: 1. Manipulation and cast fixation: The doctor fixes the talar head with the thumb, elevates the first metatarsal to correct the high arch deformity, then continues to fix the talar head and abducts the rotated forefoot, in this consistent maneuver, all the deformity components of the clubfoot are gradually corrected at the same time. The foot is abducted as far as tolerated by the infant, maintained in this position with appropriate force and immobilized in a knee flexion position with a long-legged tubular cast. As the forefoot is abducted, the heel inversion deformity is gradually corrected. Generally, through 4~5 times of manipulation and long-leg cast fixation in knee flexion position, all deformity components except plantarflexion deformity can be completely corrected. 2, percutaneous Achilles tendotomy: (1) under intravenous general anesthesia the assistant holds the toe with one hand and the thigh with the other, disinfects the inner, posterior and lateral sides of the foot, and routinely spreads sterile towels on the skin; (2) makes an incision about 1.5 cm above the heel bone, and the assistant fixes the foot in the maximum dorsiflexion position. Do not cut into the cartilage of the heel bone, and cut the Achilles tendon after finding it. There will be a “popping” sensation when the tendon is cut. Postoperatively, the dorsiflexion can be increased by 20~25 degrees; (3) The knee is fixed in a long-leg cast in the flexed position, and the foot is abducted 60~70 degrees relative to the coronal plane of the ankle. The foot is dorsiflexed about 20 degrees, paying attention to the position of the foot relative to the thigh in the maximum external booth and overcorrected, not rotating forward. The cast is maintained for 3 weeks. 3 Brace: After removal of the last cast, wearing a foot abduction brace with a connecting rod to maintain the orthosis obtained after the last cast is a measure to prevent recurrence of the deformity by the Ponseti method, and is currently the only effective method of brace wearing: the brace should be worn day and night (not less than 23 hours per day) for the first three months, after which the brace wearing time can be shortened to 12 hours at night and 2-4 hours during the day. After that, the brace can be worn for a total of 14 to 16 hours per day until the child is 3 to 4 years old. Remember: the brace used in the Ponseti method is intended to maintain the acquired orthosis and prevent recurrence, not to correct the deformity; some issues to be noted during the procedure: 1. The plaster shaping technique is particularly emphasized in the Ponseti method, where the plaster is kept in the corrected position, first below the knee up to the toes and then up to the base of the thigh. The cast should be even and flat, and the cast shaping is dynamic. The shaping is done with the fingers until the cast is set. In the majority of cases, plantarflexion deformity cannot be completely corrected by manipulation, and when the abducted forefoot and tibia are externally rotated in the coronal plane up to about 70°, there is still residual plantarflexion deformity, at which time This is an indication for percutaneous Achilles tendotomy to correct the plantarflexion deformity. After percutaneous Achilles tendotomy, all deformities of the clubfoot have been corrected. In order to obtain good healing and maintain the Achilles tendon at the proper length and to reduce scar tissue, a final three-week long-leg cast fixation is required. 2. Some questions about recurrence: Regardless of the method of treatment, clubfoot has a stubborn tendency to recur. After treatment with the Ponseti method, failure to wear the foot abduction brace as required by the physician or failure to wear it for the required time is the most fundamental cause of recurrence of clubfoot deformity. The recurrence of any part of the deformity in the clubfoot is considered a recurrence of clubfoot deformity. If the child is unable to wear the brace as required, frequent visits for review should be required, or if the parents suspect that the child has an abnormal foot shape, they should also seek immediate medical attention. Treatment of recurrent clubfoot is based on the Ponseti method: the same manipulation and cast fixation are used again, and percutaneous Achilles tendon severance is required if the ankle dorsiflexion is limited; for recurrent clubfoot over the age of 2 years, if the child has a dynamic forefoot with a wobbly gait after the fixed deformity has been corrected by manipulation and cast fixation If the child’s walking gait is wobbly with a dynamic forefoot, he or she should undergo a tibialis anterior muscle transfer to the third cuneiform bone to establish a muscle balance to prevent recurrence of the deformity. The Ponseti method requires not only the physician’s strict compliance with the method, but also the parents’ active and effective cooperation: (1) Manipulation and plaster: This procedure is done in the plaster room of the hospital outpatient clinic by the physician. For newborns, it is generally recommended not to feed the child during the 3 hours before each manipulation and cast, but to prepare the bottle (about 1 bottle of milk for one foot) before the doctor starts the treatment and to start feeding when the manipulation begins. (2) brace (this stage is extremely critical): the doctor usually instructs the method and time of brace wearing to prevent the recurrence of deformity, but the child at this stage is under the care of parents to complete the brace wearing, so parents must realize the important role of good brace wearing to prevent the recurrence of deformity, and must fully follow the doctor’s requirements to wear the brace, which is the key to the success of treatment; (3) recurrence: not according to the doctor’s (3) Recurrence: Failure to wear the foot abduction brace as required by the doctor or failure to achieve the required wearing time is the most fundamental reason for recurrence of clubfoot deformity after the Ponseti method. The recurrence of any part of the deformity of the clubfoot is considered a recurrence of clubfoot deformity. If the child cannot wear the brace as required, frequent visits for review should be made, or the parents should immediately consult the doctor if they suspect that the child has an abnormal foot shape.