Clubfoot Casting without Tenotomy

Pediatric Orthopaedic Clinic

What is Clubfoot?

Congenital clubfoot is a common condition worldwide. A child with clubfoot has an abnormally positioned foot, causing the ankle to turn inward.

While this condition is rarely painful during infancy, if left untreated, the child will be unable to walk properly, wear normal shoes, or participate in sports.

Non-operative treatment is usually successful and the Ponseti method is very popular, in spite of the need for Achilles tenotomy in over 90% of the feet. After training with various methods including the Ponseti method, Dr. Gourineni has developed a variation that avoids Achilles tenotomy and obtains full correction with fewer cast changes.


This is a problem that some babies are born with. One or both feet are turned inward and downward. A clubfoot is hard to push into the correct position.

Chicago Method Principles

  1. Equinus should be stretched from the beginning without breaking the midfoot.
  2. Peritalar reduction corrects cavus, adductus, and equinus simultaneously.
  3. Dorsiflexion of the talus by pushing up on the calcaneus.
  4. Equinus can be effectively stretched with midfoot locking even in rocker bottom feet.

Our Technique

We start treatment as soon as the child presents. Peritalar reduction and short leg, soft fiberglass cast till forefoot abducts. Then, long leg soft fiberglass casts till over-correction of 50 degrees of abduction and 10-20 degrees of dorsiflexion of the ankle are obtained. Maintain correction with Dennis Brown bar type of splint and frequent manipulations by parents.

When an Injury Occurs

Direct To Specialist The First Time

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