## Ponseti Method: Sequence of Correction **Key Point:** The Ponseti method follows a specific sequential order of correction, and deviating from this sequence reduces efficacy and increases relapse rates. ### The Correct Ponseti Sequence 1. **Adductus correction first** — The forefoot is abducted around the talar head as the fulcrum. This is the first and most important step. 2. **Varus correction second** — Once adductus is corrected, the heel varus is addressed by supinating the foot. 3. **Equinus correction last** — Plantarflexion is corrected last, typically by Achilles tenotomy at 8–12 weeks of age. 4. **Abduction maintenance** — The foot is held in 70° abduction and 15° external rotation in a brace. **High-Yield:** Remember the sequence as **"Adductus → Varus → Equinus"** (AVE). This is the **reverse order** of how the deformities appear anatomically (equinus is the most obvious), but it is the biomechanically correct order for correction. **Clinical Pearl:** The key insight is that the talus acts as a **fulcrum**. By abducting the foot around the talar head, the adductus is corrected first, which then allows the varus and equinus to be addressed in subsequent steps. **Mnemonic:** **"AVE Ponseti"** — Adductus, Varus, Equinus in that order. **Warning:** Attempting to correct equinus first (as one might intuitively do) leads to a "rocker-bottom foot" deformity and poor outcomes. The sequence is non-negotiable. 
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