Ponseti treatment at RNOH
The RNOH offers comprehensive assessment and treatment for children with Congenital Talipes Equino Varus (CTEV) foot position, also known as Club Foot deformity. The Ponseti method of correction is recognised as being the primary treatment of choice, and we follow Professor Ponseti’s original treatment protocol. The service at the RNOH has been well established for 19+years under the management of Ms Sally Tennant, Consultant Orthopaedic Surgeon. The team has expanded to include a Consultant Paediatric Physiotherapist specialised in CTEV management and a Ponseti practitioner. We are now a busy service receiving primary and secondary referrals for three to four new babies every month.
Following a diagnosis of a potential clubfoot deformity on the antenatal 20 week anomaly scan, we offer ante-natal counselling to explain and advise about the diagnosis and its treatment. We have shown that this can reduce parental anxiety both prior to the birth and during the initial stages of treatment.
We usually begin the Ponseti treatment at two to three weeks following delivery. Above knee plaster casts are applied on a weekly basis to manipulate and correct the foot position. Usually four to six weeks of casting are required prior to an Achilles tendon tenotomy operation which is performed in clinic under local anaesthetic. Following this, three further weeks of casting are needed and then a Foot Abduction Brace is fitted. This is worn for three months for 23 hours a day and then at night times and nap times for five years.
The Ponseti plaster technique corrects the foot to a normal position in the vast majority of cases, and the Foot Abduction Brace is required to keep the foot in a corrected position. Compliance with the treatment and the bracewear results in normal levels of function and ability for the vast majority of children with this condition.
The Ponseti Team:
Miss Sally Tennant FRCS, Consultant Orthopaedic Surgeon
Christine Douglas, Consultant Paediatric Physiotherapist
Cicily James, Specialist Ponseti Practitioner
Key contacts
General enquiries: rnoh.ponseti@nhs.net
Secretary: rnoh.
Clinical queries: Christine Douglas: christinedouglas1
Plaster room tel: 0208 909 5467
Further reading:
Health Professionals - Charity Work | Steps Charity (stepsworldwide.org)
Clubfoot Archives - Global HELP (global-help.org)
Referrals:
Please download the printable referral forms for:
- Antentatal counselling following diagnosis of suspected CTEV / clubfoot deformity
- Assessment of CTEV / Talipes / Clubfoot and Ponseti treatment if needed
and email to rnoh.
- Referrals from GPs to the unit are now only accepted electronically via the NHS Digital Electronic Referrals Service (ERS) - see below. Please do not be concerned about the eRS appointment date associated with Choose & Book. Upon department receipt, the referral will be triaged and urgent referrals will be prioritised for earlier review. We will aim to see babies referred for assessment of neonatal hip dysplasia or clubfoot deformity within two weeks.
ERS Guide how to find the RNOH
If you are a GP referring to the RNOH please use the NHS e-Referral Service system, e-RS. Find out more about e-RS and the benefits for patients.
What is e-RS?
E-RS is the NHS electronic patient referral service used to refer patients to a consultant-led service. This is for new first outpatient appointments only. All other appointments must be booked as per the current process.
Benefits for Patients
It gives patients as much choice as possible and where practicable, empowering patients to make the booking themselves.
Improves patient convenience. e-RS allows them to plan their visit for a time that best suits their family and work life.
There is significant evidence that patients who are empowered to choose their own appointment are far more likely to attend their clinic slot.
Similarly, where patients have greater choice, there is a reduction in rearranged appointments.
e-RS provides an electronic trail of records that can be easily traced.
And, by removing paper referrals we can speed up appointment confirmation for patients at the click of a button.
Benefits for the Trust
Patient choice and better control
Safety: referral visibility and audit trail
Operational: easier referral trail, reduction in the number of enquires
Finically: reduced DNA’s and cancellations- data from previous electronic booking pilots show that when patients are given the choice of date and time for their appointment they are more likely to attend. This leads to fewer wasted appointments and helps to improve the efficiency of outpatient clinics
What happens when a patient is referred electronically using e-RS?
Where the service is ‘directly bookable’ patients will have the ability to book into an available appointment (as a provisional appointment) that is convenient for them to attend. The referral will be reviewed (triaged) by the relevant consultant and will be accepted, rejected or referred on (to another RNOH colleague). The outcome of the review will be communicated to the GP and the patient. For rejected referrals, this will mean that the provisional appointment is cancelled and for accepted referrals, it will mean that the provisional appointment is confirmed.
For ‘indirectly bookable’ services, patients will be given a paper by the GP which should contain a UBRN, passcode and a telephone number to call to activate the referral. It is only once the patient calls the RNOH, that the RNOH will have access to the referral information on e-RS. The referral will be passed to the relevant consultant to review and a decision to accept or reject will be made and the patient and GP notified accordingly.
What happened if there are no appointments?
There may be instances where a patient cannot select an appointment (for directly bookable services) when attempting to book the appointment. When this happens, practices or patients should always choose the ‘Defer to Providers’ option. These are known as 'Appointment Slot Issues' and are caused because there are no available slots for the service the patient is being referred to.
Appointment Slot Issues (ASIs) and Defer to the provider
When there is no capacity available for a service on e-RS and referring GPs, use the 'Defer to Provider' option, an Appointment Slot Issue is created. The service will manage the Appointment Slot Issue worklist, create capacity for the Appointment Slot Issue and then book the patient an appointment via e-RS when there is capacity available.
Sarcoma clinics are also supported by the NHS e-Referral Service. Please ensure that the suspected sarcoma referral form is used for all 2WW referrals. This form can be found here Contact Details for GPs and Pan-London & South East Sarcoma Network Referral Form.
Booking for NHS e-referral service appointment
Patients can book, change or cancel their appointment online and by phone.
To book or amend an appointment online, please visit: NHS e-Referral Service
To book or amend an appointment by phone, please contact the national e-Referral Service appointment line: 0345 6088 888 or 0845 850 2250 for their textphone service.
NHS e-referral contact times
Monday to Friday: 8am to 8pm
Weekends and bank holidays: 8am to 4pm
e-RS appointment line: 0345 6088 888
Text phone service: 0845 850 2250
Please use the reference number and password from the patient appointment request letter, you will need to have this in front of you to book an appointment.
Key Contacts
If you have any concerns or queries about e-RS / problems finding clinics/ paper switch-off process, please contact:
Amanda Peel, Elective Access Manager
Tel: 020 8385 3058
Elective Access Management Team at rnoh.