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Orthopaedics · Paediatric orthopaedics
Sample itemA newborn has a rigid foot with the heel in equinus and varus, forefoot adduction and a high arch. What is the recommended first-line treatment?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
C. Serial manipulation and casting by the Ponseti method
Idiopathic clubfoot (talipes equinovarus) has the components cavus, adductus, varus and equinus. Ponseti serial manipulation and casting, often followed by percutaneous Achilles tenotomy and then bracing, corrects most feet without major surgery.
Option by option
A. Posteromedial soft tissue release in the first week
Extensive release is reserved for resistant feet after conservative treatment fails.
B. Triple arthrodesis
Triple arthrodesis is a salvage procedure for severe deformity in older children or adults.
C. Serial manipulation and casting by the Ponseti method (correct)
Gentle weekly manipulation and casting corrects the deformity early while the tissues are pliable.
D. Observation until the child begins to walk
Waiting allows the deformity to become fixed and harder to correct.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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