THE IMPORTANCE OF FOLLOWING THE ORIGINAL PONSETI METHOD IN TREATMENT OF CLUBFOOT: THE IOWA EXPERIENCE

Abstract

Dr. Ignacio Vives Ponseti, an American orthopaedic surgeon with Spanish origin, was born on June the 3rd, 1914 and died at the age 95 in Iowa, USA, on October 18th 2009. He was a brilliant pediatric orhopaedic surgeon, best known for his method of nonoperative treatment of clubfoot, that has become a gold standard of clubfoot treatment. His iconic paper on clubfoot management (1963) is one of the few manuscripts in orthopaedic literature which has radically changed the practice as we know it now. The Ponseti method is easy to learn but, unfortunately easy to modify because modification negatively affects the treatment outcome. That emphasizes the need to learn and follow the exact steps explained by Dr. Ponseti. The first author of this article had the opportunity to learn this method in the place where it all started, guided by Dr. Jose Morcuende, the successor of Dr. Ponseti who continues his legacy in the brightest way possible. After return from the stay at Iowa Stead Family Children’s Hospital 16 patients and 23 feet were treated with best possible adherence to the Ponseti Method. We began using the original Ponseti method in October 2019. Since then, 16 patients, 7 bilateral, 9 unilateral (23 feet in total) have been treated and evaluated. We strove as much as possible to reproduce Ponseti’s strict casting protocol faithfully, as explained in the paper. Usually, for correction of the first three components 4 to 10 casts are necessary, changed on a weekly basis. Equinus is the last deformity to be corrected. In order to avoid prolonged casting and concomitant appearance of rocker bottom deformity, the correction of equinus is facilitated by a simple operative procedure in local anesthesia. Sixty five percent of the patients had good results, 31% had acceptable results, in one patient there was poor result. Compared to the original Ponseti paper from 1963, there is not any significant difference in the results, except the bigger percent of poor results that involves only one patient in our series.