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Applied Bionics and Biomechanics
Volume 2019, Article ID 4308462, 11 pages
Review Article

An Analysis of the Mechanical Properties of the Ponseti Method in Clubfoot Treatment

1Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, Oxford University, UK
2Department of Materials, Oxford University, UK

Correspondence should be addressed to Murtaza Kadhum;

Received 6 November 2018; Accepted 14 January 2019; Published 25 March 2019

Academic Editor: Jose Merodio

Copyright © 2019 Murtaza Kadhum et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Congenital clubfoot is a complex pediatric foot deformity, occurring in approximately 1 in 1000 live births and resulting in significant disability, deformity, and pain if left untreated. The Ponseti method of manipulation is widely recognized as the gold standard treatment for congenital clubfoot; however, its mechanical aspects have not yet been fully explored. During the multiple manipulation-casting cycles, the tendons and ligaments on the medial and posterior aspect of the foot and ankle, which are identified as the rate-limiting tissues, usually undergo weekly sequential stretches, with a plaster of Paris cast applied after the stretch to maintain the length gained. This triggers extracellular matrix remodeling and tissue growth, but due to the viscoelastic properties of tendons and ligaments, the initial strain size, rate, and loading history will affect the relaxation behavior and mechanical strength of the tissue. To increase the efficiency of the Ponseti treatment, we discuss the theoretical possibilities of decreasing the size of the strain step and interval of casting and/or increasing the overall number of casts. This modification may provide more tensile stimuli, allow more time for remodeling, and preserve the mechanical integrity of the soft tissues.