In 2002 a previously unrecognized embryological foot structure, the PreClinical Clubfoot Deformity, was described in the Journal of Bodywork and Movement Therapies (Rothbart, 2002). In that paper, it was suggested that the PreClinical Clubfoot Deformity is a milder form of the Clubfoot Deformity in which the heel supinatus (inward twisting of the foot) and talipes equinus (downward position of the foot) is not as severe as seen in the Clubfoot Deformity.
Even though the PreClinical Clubfoot Deformity is a milder form of the Clubfoot Deformity, the treatment for these two embryological foot structures is entirely different:
Non-surgical treatment of the Clubfoot Deformity - The Ponseti Method
The Ponseti Method (named after Dr Ignacio Ponseti, 1914 - 2009) advocates treating the Clubfoot Deformity with serial casts (See Photos below) starting within the first two to three months after birth.Typically this incorporates a series of four to six casts over a period of one to two months to reposition and hold the foot in its correct position. In some cases, a microscopic incision into the Achilles tendon is required toward the end of the serial casting.
Ponseti Serial Casting - Courtesy of University of Missouri, School of Medicine, Department of Pediatric Orthopedics
Maintenance therapy is usually required for up to four years after casting. This involves using a foot abduction splint. The reported rate of success is upwards of 95% if the casting and post splinting are applied correctly.
The Ponseti Method is not used for treating the PreClinical Clubfoot Deformity.
Non-surgical treatment of the PreClinical Clubfoot Deformity - Rothbart Proprioceptive Therapy
Rothbart Proprioceptive Therapy (named after Professor/Dr. Brian A. Rothbart, 1943 - ) advocates treating the PreClinical Clubfoot Deformity using a specific type of proprioceptive therapy, starting no earlier then four years of age. Typically this involves a series of tests, computer postural analyses, specific prescriptive proprioceptive insoles and ongoing monitoring, for a period of 12-18 months. After this time, the patient uses the prescriptive insoles as needed, for the rest of their life.
Rothbart Proprioceptive Therapy is not indicated nor used for treating the Clubfoot Deformity.
Rothbart BA, 2002. Medial Column Foot Systems: An Innovative Tool for Improving Posture. Journal of Bodywork and Movement Therapies (6)1:37-46