Congenital clubfoot is a common condition worldwide. Nonoperative treatment is usually successful and 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 avoided Achilles tenotomy and obtained full correction with fewer cast changes.
Chicago Method Principles
- Equinus should be stretched from the beginning without breaking the midfoot.
- Peritalar reduction corrects cavus, adductus, and equinus simultaneously.
- Dorsiflexion of the talus by pushing up on the calcaneus.
- Equinus can be effectively stretched with midfoot locking even in rocker bottom feet.
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.
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