Which is the preferred non-surgical treatment for congenital clubfoot (talipes equinovarus)?

• A. Open surgical release of the foot
• B. Ponseti method of serial manipulation and casting
• C. Long-term immobilization with casting alone
• D. Observation and passive stretching only

Answer: (B)

The preferred non-surgical approach is the Ponseti method, which uses gentle, systematic manipulation followed by serial casting to gradually realign the foot and soft tissues. This targets all four components of the deformity—cavus, forefoot adduction, hindfoot varus, and ankle equinus—by lengthening and repositioning structures over several weeks. Most infants ultimately need a percutaneous Achilles tendon tenotomy to release tightness and allow full correction. After correction, wearing a foot-abduction brace helps maintain alignment and prevent relapse. Compared with surgical release, long-term immobilization with casting alone, or passive stretching, the Ponseti method offers high success with fewer complications and preserves more joint mobility, making it the best non-surgical option.