A Modified Ponseti Method for Skeletally Mature Complex Foot Deformities
Brandon Zaldivar1,2, Jaime Alfredo Schuster-Wasserman1,3, Martha Lorena Caicedo-Gutiérrez1
1Roosevelt Pediatric Orthopedic Institute, Orthopedics and Traumatology Research Group, Bogotá, Distrito Capital, Colombia.
Foot & Ankle International
|July 17, 2026
Summary
Serial casting using a modified Ponseti method (PM) effectively corrects complex foot deformities (CFDs) in adults, reducing the need for extensive surgery. This approach achieves plantigrade feet with a low relapse rate, offering a valuable treatment option.
Area of Science:
- Orthopedic surgery
- Pediatric orthopedics
- Foot and ankle reconstruction
Background:
- Managing complex foot deformities (CFDs) in skeletally mature patients presents significant challenges.
- The effectiveness of the Ponseti method (PM) beyond childhood for CFDs is not well-established.
Purpose of the Study:
- To assess the efficacy of serial casting as a presurgical correction strategy for adolescent and adult patients with idiopathic and acquired complex foot deformities.
- To evaluate improvements in foot deformity and patient outcomes following a modified Ponseti method.
Main Methods:
- A retrospective cohort study of 58 skeletally mature patients (78 feet) with idiopathic or acquired CFD treated with a modified PM (2020-2024).
- Deformity severity (cavus, varus, adductus, equinus) was assessed at baseline, post-casting, and postoperatively.
- Statistical analysis (ANOVA, Tukey's test) evaluated changes; complications and Foot and Ankle Outcome Score (FAOS) were reported.
Main Results:
- Serial casting significantly improved all deformity planes (P < .001) in both idiopathic and acquired CFD groups.
- A plantigrade foot was achieved in 89% of cases; 95% required additional procedures post-casting.
- Median FAOS was 87 for idiopathic and 85 for acquired CFD; relapse occurred in 13% after 17 months.
Conclusions:
- Modified Ponseti method serial casting reduces the need for complex reconstructive surgery in adult CFDs.
- This approach yields high rates of plantigrade feet and low rates of arthrodesis.
- The method offers a potential paradigm shift for treating multiplanar foot deformities, especially in resource-limited settings.
