Walking Age of Infants Treated with Ponseti Method for Idiopathic Clubfoot

Volume 7 | Issue 3 | September-December 2021 | Page: 08-12 | Devashis Barick, Nilesh Joshi, Nikhil Tiwari, Amit Nemade, Ameya Sawarkar


Authors: Devashis Barick MS Ortho. [1], Nilesh Joshi MS Ortho. [1], Nikhil Tiwari MS Ortho. [1], Amit Nemade MS Ortho. [1], Ameya Sawarkar MS Ortho. [1]

[1] Department of Orthopaedics, NKP SIMS & RC, Nagpur, Maharashtra, India.

Address of Correspondence
Dr Amit Nemade
Assistant Professor, Department of Orthopaedics, NKP SIMS & RC, Nagpur, Maharashtra, India.
E-mail: kidsorth@gmail.com


Aim- Parents of children affected with idiopathic clubfoot are anxious that motor development should progress normally. Treatment using Ponseti Method involves cast immobilization, bracing and tenotomy which inhibit the normal movement thereby increasing parental concern. The purpose of this study was to evaluate age at which independent walking was established in infants with idiopathic clubfoot treated using Ponseti method.
Materials & Methods- There were 70 patients in this prospective longitudinal study. All subjects were full term at birth, less than 12 weeks of age at the initiation of treatment for clubfoot and no prior outside treatment had been provided. Patients were treated using the Ponseti method. The children were evaluated prospectively for the commencement of independent walking.
Results- The mean age at which independent walking started was 13.64 + 2.74 months (9 months-22 months). Fifty percent of the affected children were walking by the age of 14 months. Children with relapse walked later by 2.8 months (p=0.017). Children with a family history walked at 11.7 months (p=0.049) which was significantly earlier than the patients without a family history. Other variables had no significant influence on walking age.
Conclusion- A delay of 1.5 months in independent walking age is expected in children with idiopathic clubfoot, which is helpful while counselling the parents at the start of treatment. Relapse during treatment delays walking age further.
Keywords: CTEV, Motor milestone, Independent walking.


1. Bacino CA, Hecht JT. Etiopathogenesis of equinovarus foot malformations. Eur J Med Genet [Internet]. 2014;57(8):473–9. Available from: http://dx.doi.org/10.1016/j.ejmg.2014.06.001
2. Dobbs MB, Gurnett CA. Update on clubfoot: Etiology and treatment. Clin Orthop Relat Res. 2009;467(5):1146–53.
3. Ponseti I, Smoley E. Congenital Club Foot: The Results of Treatment. J Bone Jt Surg. 1963;45(2):261–344.
4. Sala DA, Chu A, Lehman WB, Van Bosse HJP. Achievement of gross motor milestones in children with idiopathic clubfoot treated with the Ponseti method. J Pediatr Orthop. 2013;33(1):55–8.
5. Andriesse H, Westbom L, Hägglund G. Motor ability in children treated for idiopathic clubfoot. A controlled pilot study. BMC Pediatr. 2009;9(December).
6. Garcia NL, McMulkin ML, Tompkins BJ, Caskey PM, Mader SL, Baird GO. Gross motor development in babies with treated idiopathic clubfoot. Pediatr Phys Ther. 2011;23(4):347–52.
7. Hughes K, Gelfer Y, Cokljat M, Wientroub S, Yavor A, Hemo Y, et al. Does idiopathic congenital talipes equinovarus have an impact on attainment of developmental milestones? A multicentre international study. J Child Orthop. 2019;13(4):353–60.
8. Zionts LE, Packer DF, Cooper S, Ebramzadeh E, Sangiorgio S. Walking age of infants with idiopathic clubfoot treated using the ponseti method. J Bone Jt Surg – Am Vol. 2014;96(19):e164.
9. Dillmann J, Schwarzer G, Peterlein CD. Motor and cognitive functioning in children treated for idiopathic clubfoot at the age of 3 years. BMC Pediatr. 2019;19(1):4–9.
10. Zapata KA, Karol LA, Jeans KA, Jo CH. Gross Motor Function at 10 Years of Age in Children with Clubfoot Following the French Physical Therapy Method and the Ponseti Technique. J Pediatr Orthop. 2018;38(9):e519–23.
11. Kenmoku T, Kamegaya M, Saisu T, Ochiai N, Iwakura N, Iwase D, et al. Athletic ability of school-age children after satisfactory treatment of congenital clubfoot. J Pediatr Orthop. 2013;33(3):321–5.
12. Aulie VS, Halvorsen VB, Brox JI. Motor abilities in 182 children treated for idiopathic clubfoot: A comparison between the traditional and the ponseti method and controls. J Child Orthop. 2018;12(4):383–9.
13. Gundawar CS, Desai SS, Borkar SS, Ranade A, Patel S, Oswal A V. Prospective Study of Gross Motor Milestones in Children with Severe Idiopathic Clubfoot Treated by Ponseti Method. Indian J Orthop [Internet]. 2021;55(1):183–7. Available from: https://doi.org/10.1007/s43465-020-00214-3
14. Dyer PJ, Davis N. The role of the Pirani scoring system in the management of club foot by the Ponseti method. J Bone Jt Surg – Ser B. 2006;88(8):1082–4.
15. Bhaskar A, Patni P. Classification of relapse pattern in clubfoot treated with Ponseti technique. Indian J Orthop. 2013;47(4):370–6.
16. Zanardi A, Fortini V, N. Abati C, Bettuzzi C, Salvatori G, Prato E, et al. Standing and walking age in children with idiopathic clubfoot: French physiotherapy versus ponseti method. J Child Orthop. 2019;13(5):471–7.
17. Capute AJ, Shapiro BK, Palmer FB, Ross A, Wachtel RC. Normal Gross Motor Development: the Influences of Race, Sex and Socio‐Economic Status. Dev Med Child Neurol. 1985;27(5):635–43.
18. Davis BE, Moon RY, Sachs HC, Ottolini MC. Effects of sleep position on infant motor development. Pediatrics. 1998;102(5):1135–40.
19. De Onis M. WHO Motor Development Study: Windows of achievement for six gross motor development milestones. Acta Paediatr Int J Paediatr. 2006;95(SUPPL. 450):86–95.
20. Prudham GND. Norms for Four Standard Developmental Milestones by Sex, Social Class and Place in Family. Dev Med Child Neurol. 1969;11(4):413–22.
21. Lööf E, Andriesse H, André M, Böhm S, Iversen MD, Broström EW. Gross Motor Skills in Children with Idiopathic Clubfoot and the Association between Gross Motor Skills, Foot Involvement, Gait, and Foot Motion. J Pediatr Orthop. 2019;39(7):359–65.
22. Karol LA, Jeans KA, Kaipus KA. The Relationship Between Gait , Gross Motor Function , and Parental Perceived Outcome in Children With Clubfeet. J Pediatr Orthop. 2016;36(2):145–51.
23. Majnemer A, Rosenblatt B. Reliability of parental recall of developmental milestones. Pediatr Neurol. 1994;10(4):304–8.

How to Cite this Article:  Barick D, Joshi N, Tiwari N, Nemade A, Sawarkar A Walking | Age of Infants Treated with Ponseti Method for Idiopathic Clubfoot | International Journal of Paediatric Orthopaedics | September-December 2021; 7(3): 08-12.

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