Q&A Forum & Inquiries

Clubfoot treatment using the Ponseti Method (serial plaster casting) should ideally begin within the **first 2 weeks of life** (typically 7 to 10 days after birth). At this stage, a baby's tendons, ligaments, and bones are highly elastic and respond quickly to gentle corrective stretching.

However, if treatment was delayed, the Ponseti method remains highly effective for older infants and toddlers up to age 2, though correction may take a few extra casting phases.

No, surgery is rarely the first step. For children with idiopathic toe walking (toe walking with no neurological cause), non-surgical solutions are the primary focus:

• Physical Therapy: Calf muscle stretching and Achilles tendon elongation exercises.
• Orthotics: Custom ankle-foot orthoses (AFOs) or night splints to encourage flat-foot walking.
• Serial Casting: A short series of walking casts applied for 4 to 6 weeks to gently stretch tight calves.

Surgical tendon lengthening is only reserved for older children (usually over 5 or 6 years) who have developed a fixed tendon contracture that does not respond to conservative therapies.

A Pavlik harness is a specialized, soft cloth brace used to treat **Developmental Dysplasia of the Hip (DDH)** in infants under 6 months. It holds the baby's hips in a bent (flexed) and spread-out (abducted) position, keeping the hip ball securely centered in the socket to promote normal joint development.

Wear Schedule:

• Initial Phase: Typically worn **23 to 24 hours a day** for 6 to 12 weeks.
• Weaning Phase: Gradually reduced to night-only wear over several weeks based on ultrasound progress checkups.

In most children under the age of 5 or 6, flat feet are completely **normal and physiological**. Toddlers have a thick fat pad in their instep that hides the arch, and the arch-supporting ligaments are still developing. As long as the flat foot is flexible (an arch appears when the child stands on tiptoes) and does not cause pain or limping, **no treatment or special orthopedic shoes are necessary**.

Treatment (using customized shoe inserts or exercises) is only indicated if the flat feet are:

• Symptomatic: Causing pain in the feet, ankles, or calves during walking or sports.
• Rigid: The foot remains flat even when dangling or standing on tiptoes (requires diagnostic ruling of tarsal coalition).

Bowed legs are common in babies up to 18 months, and knock knees are normal between ages 2 and 4. These are usually physiological stages that self-correct as the child grows.

When to consult a pediatric orthopedic surgeon:

• The bowing is severe, or is only affecting **one leg** (asymmetrical).
• The bowing continues to worsen after **18 months** or knock knees persist after **6 years**.
• The child complains of knee pain, limps, or has difficulty running.
• The child's height is significantly below average for their age (ruling out rickets or skeletal dysplasias).