A newborn is noted to have a right foot that is fixed in equinus, varus, and adduction with internal tibial torsion. Pirani scoring is 4.5/6. Which is the CURRENT first-line treatment method and what is the weekly casting protocol?
- A French physiotherapy (functional) method with daily stretching and strapping; surgical correction if residual deformity at 6 months
- B Immediate surgical posteromedial release (McKay/Carroll procedure) at 3 months of age
- C Ponseti method with weekly serial above-knee casts correcting cavus first, then forefoot adduction, varus, and finally equinus; followed by Achilles tenotomy if required ✓
- D Denis Browne boot with straight last shoes and serial below-knee casts
Explanation
The Ponseti method is the globally accepted gold standard for CTEV. Correction proceeds in a specific sequence with weekly above-knee (long leg) plaster casts: first the CAVUS is corrected by supinating the forefoot (not pronating), then adduction and varus are corrected together by abducting the foot while maintaining supination and counter-pressure on the lateral head of talus, and finally EQUINUS is corrected last — with Achilles tenotomy needed in ~80–90% of cases. The Denis Browne abduction brace is worn post-correction for maintenance. Immediate surgical release has higher complication rates and is now reserved for failures.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
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Written and medically reviewed by the StethoPrep medical team.