Gentle manipulation to bring the affected foot to a normal position is the beginning of the Ponseti treatment. The correction is achieved gradually through weekly manipulation and plaster casting. For both the manipulation and plaster cast, the fulcrum remains the head of the talus bone. Each week after a few minutes of gentle manipulation, a plaster cast is carefully applied to keep the foot in the manipulatively achieved corrected position. There is a very specific hand position that has to be followed while manipulating the foot. Healthcare professionals who attend formal training on the Ponseti method are taught the details of hand position, gentle manipulation and firm (but not so tight) casting from toes to groin. While manipulation and casting, the right foot is held with the left hand with the thumb on the head of the talus. The left foot is held with the right hand with the thumb on the head of the talus bone.
After a week, the foot under treatment is gently manipulated again with the head of the talus bone as the fulcrum. The foot continues to be gently manipulated to gradually bring it to the normal position. Every week for the next four to six weeks the foot is manipulated and a full leg cast is applied. The manipulation is very gentle and the cast is given very carefully from toes to groin to successfully get complete correction at the end of the casting phase. Generally, this weekly cast phase takes four to six weeks. The number of casts may increase or decrease based on the spectrum/type of clubfoot and the age of the child at the beginning of the treatment.
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