Explain a clubfoot diagnosis and the Ponseti method to a parent — OSCE

Communication framework

Establish what the mother already understands and fears. Ask her to tell you, in her own words, what the midwife or the doctor told her about the foot, and what she is most worried about. The fear that her son will never walk, the anxiety about the operation, and the overwhelm of the brace for years are the three emotions you will spend the most time addressing, and you address them with the plain language, the realistic prognosis, and the evidence that the Ponseti method works. Do not launch into the plan before you have heard her. [1][5]

Explain the diagnosis in plain language. Tell her that her son has a clubfoot, a condition where the foot is turned inward and downward at birth, and that it is structural, not caused by anything she did in the pregnancy. About one in a thousand babies are born with a clubfoot, and boys are affected twice as often as girls. Reassure her that the foot is normal in its bones and its structure, and that the deformity is in the soft tissues — the ligaments and the tendons — that hold the foot in the wrong position. The treatment will move the foot to the correct position and hold it there. [5][2]

Explain the Ponseti method in plain language. Tell her that the treatment is called the Ponseti method, after the doctor who developed it, and that it is the global gold standard, used in over one hundred countries. The treatment has three parts. The first part is the serial casting: five to seven weekly long-leg casts, from the toes to the top of the thigh, that gently move the foot to the correct position over five to seven weeks. The second part is a small procedure, called a percutaneous Achilles tenotomy, to release the tight tendon at the back of the ankle, performed under the local anaesthetic in most cases, with a three-week cast afterwards. The third part, and the most important, is the foot-abduction brace — a pair of shoes connected by a bar, holding the feet in the turned-out position — worn twenty-three hours a day for the first three months, then nightly to the age of four to five years. [1][3]

Address the fear of the operation. Tell her that the extensive operation she has heard about is from the previous era, and the Ponseti method was designed to prevent it. The percutaneous tenotomy is a minor procedure, not an operation, and the extensive soft-tissue release is now reserved for the rare resistant case. The Morcuende 2004 study showed the radical reduction in the rate of the extensive surgery when the Ponseti method was adopted, and the Cooper and Dietz thirty-year follow-up showed the normal function at thirty years. [3][2]

Address the overwhelm of the brace. Tell her that the brace is the key to the permanent correction, and that the family is the most important partner in the treatment. The first three months, with the twenty-three-hour wear, are the hardest, and the family support and the peer network are there to help. After the first three months, the brace is worn at the night and the nap, and most children accept it as part of their routine. The brace compliance is the single greatest determinant of the long-term success, and the regular review and the open communication with the team are the safeguards. [3][5]

Address the fear about walking. Tell her that the long-term outcome is excellent: the child will walk, run, and play sport normally, with only a slightly smaller calf and a slightly smaller foot on the affected side. The Cooper and Dietz thirty-year follow-up of the Ponseti method showed the near-normal function and the painless feet, and the patient functions normally in the daily life. [2]

Shared decision-making

Check the understanding. Ask the mother to tell you, in her own words, what she has understood about the diagnosis, the three parts of the treatment, and the brace. The check of the understanding is the safeguard that prevents the miscommunication, and the mother who can repeat the plan is the mother who will adhere to it. [5]

Agree on the plan. Confirm the referral to the paediatric orthopaedic clinic, the start of the Ponseti casting within the first week or two of life, the percutaneous tenotomy at eight to ten weeks, and the foot-abduction brace for four to five years. Confirm the multidisciplinary support — the physiotherapist for the brace fitting, the peer-support network for the family, and the regular review. Confirm the safety-net: the mother can contact the team at any time with the questions or the concerns. [1][3]

Marking domains

Communication (5 marks). The candidate establishes the rapport, listens to the fears, uses the plain language without the jargon, checks the understanding, and addresses the three emotions — the fear about the walking, the anxiety about the operation, and the overwhelm of the brace. [5]

Knowledge (5 marks). The candidate explains the diagnosis accurately, the three parts of the Ponseti method, the percutaneous tenotomy, the foot-abduction brace protocol, the long-term outcome, and the evidence from the Ponseti, the Morcuende, and the Cooper and Dietz studies. [2][3]

Shared decision-making (5 marks). The candidate agrees on the plan with the mother, confirms the referral, the timeline, and the multidisciplinary support, and provides the safety-net. [1]

Family-centred care (5 marks). The candidate frames the clubfoot as a treatable, family-centred condition, addresses the brace compliance as the family's work, and offers the peer-support network. The candidate who treats the mother as the partner in the treatment is the candidate the boards reward. [5][3]