Our grandson was born six weeks ago with a clubfoot deformity. He is being treated at a physical therapy clinic where they move his foot and hold it in a corrected position and then put a cast on it for awhile. This is an awkward question, but the therapist looks like he’s just out of high school. How can we be sure he really knows what he’s doing? We don’t want to be overbearing grandparents, but we’re concerned.

Your concern is completely justified. In today’s health care arena, every patient and family member must be an advocate for their own health. And that is especially true with infants and young children who have no way of judging what’s going on. In the case of clubfoot deformity, early treatment is essential to obtain proper foot and ankle alignment needed for walking.

The Ponseti Method of treatment that you described is a well-known and successful approach to clubfoot correction. The therapist carefully manipulates the bones of the foot one at a time in a prescribed order. Casting is used to maintain the correction. A week later, the cast is removed and the next bone is corrected. The manipulation procedure takes one to three minutes and requires correct hand placement and just the right amount of force. This process is repeated five to eight times over a period of five to eight weeks until everything is lined up anatomically as it should be.

Physical therapists are trained to perform these movements. Their skill in anatomy and palpation makes them a good choice to carry out this procedure. Training often involves practice using X-rays of the misaligned bones of the feet and a moveable model of the bones of the foot. The therapist uses these tools to practice the finger placement and amount of pressure to apply over each bone.

Many therapists learn the specific application of these manipulation techniques from orthopedic surgeons or other therapists already experienced in the Ponseti method. Some attend a specific course designed to teach this approach. The success of this method depends, in part, on the skill of the person applying the correction and casting. Don’t be afraid to express your concerns and ask the therapist what kind of training he has received in order to perform these techniques.