Ignacio Ponseti

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Ignacio Ponseti (3 June 1914 18 October 2009) was a Spanish-American physician, specializing in orthopedics. He was born on 3 June 1914 in Menorca, part of the Balearic Islands, Spain, Ponseti was the son of a watchmaker and spent his childhood helping repair watches. This skill was said to eventually contribute to his abilities as an orthopedist. [1] He served three years as a medic during the Spanish Civil War treating orthopedic injuries of wounded soldiers. He left Spain shortly after the end of the war and became a faculty member and practicing physician at the University of Iowa, where he developed his ground-breaking, non-surgical treatment for the clubfoot defect - the Ponseti Method.

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Ignacio Ponseti Vives, MD Dr Ponseti.jpg
Ignacio Ponseti Vives, MD

Biography

In the 1950s, Ignacio Ponseti developed the Ponseti method (also known as the Ponseti technique), a non-surgical technique that uses a series of casts, followed by an abduction brace, to correct congenital clubfoot. The condition causes a baby's feet to turn inward and downward; if not corrected, the child will be unable to walk or move properly. He was known for this method of clubfoot treatment that bears his name, and was Professor Emeritus in the Department of Orthopaedic Surgery at University of Iowa Hospitals and Clinics.

Education

Ponseti studied medicine at Barcelona University. Not long after he graduated, fighting broke out between the Nationalists and the Republicans - the start of the Spanish Civil War. Ponseti served as a medical officer with the Loyalists as a lieutenant, then captain, in the Orthopaedic and Fracture Service. His duties included setting fractures, which put him on a career in orthopaedics. Without ambulances, Ponseti used the help of local smugglers to take the injured into France. [1] He soon escaped to France himself and went to Mexico, where for two years he practiced family medicine. A physician there helped him get to Iowa in 1941 to study orthopaedics under Arthur Steindler, M.D. Ponseti completed a residency at Iowa in 1944 and became a member of the orthopaedic faculty at University of Iowa Hospitals and Clinics.

Early in his career at Iowa, Ponseti saw that the outcomes of clubfoot surgical treatments were not very good - patients had limited movement. He set out to develop a treatment that made the most of babies' flexible ligaments. [2] The method was met with some opposition but over the past 50 years it has been adopted by many doctors and other health care providers worldwide, including in Britain [3] and Turkey. [4]

Well into his nineties, Ponseti continued to see patients and trained visiting doctors from around the world. He also developed new prosthetic devices with John Mitchell of MD Orthopaedics, Inc. [5] and produced training and information DVDs on the method.

Ponseti's other research focused on congenital and developmental bone and joint disorders, skeletal growth disorders in children, and the biochemistry of cartilage. He gained insight in the early 1950s on the effect of amino nitriles on collagen cross linking, defined the curvature patterns of idiopathic scoliosis, and demonstrated that curves progressed after skeletal maturity. He also conducted many studies evaluating the long-range results of treatments for congenital dislocation of the hip, clubfoot and scoliosis.

The Ponseti method

Clubfoot affects well over 100,000 newborns annually. [6] Early in his career at the University of Iowa, Ponseti realized that surgical approaches did not fully correct clubfoot and/or created problems later in life, such as severe arthritis or even requiring more surgery. [2] In working to develop a new approach, he determined it could be nonsurgical. The Ponseti method uses gentle, manual manipulation of the foot, followed by application of toe-to-groin plaster casts. The casts are changed weekly after a clinician manipulates softened foot ligaments to gradually achieve near-normal muscle and bone alignment.

In addition to the improved physical outcomes, compared to surgery, the Ponseti method is less expensive and can be taught to nonphysician health care providers, which is useful in areas with few or no doctors. Clubfoot is the most common musculoskeletal birth deformity, affecting 200,000 newborn children each year worldwide, 80% of whom are in developing countries. The Ponseti method is used, for example, in Uganda, where efforts continue to improve the availability of the treatment. [7]

The Ponseti method is effective when properly applied by a trained health care provider and is considered the "gold standard" treatment, leading to a normal, productive life. Nearly 80% of children can expect an excellent to good long-term outcome; however, a minority of children will get recurrence requiring repeated treatment, or on occasion surgery. [8] Non-compliance with the method is the greatest risk-factor for failure.

At the 2007, International Clubfoot Symposium attended by 200 doctors from 44 countries, papers were presented regarding an estimated 10,000 children successfully treated with the technique around the world in recent years.

The Ponseti International Association for the Advancement of Clubfoot Treatment was founded in 2006 to improve the treatment of children born with clubfoot, through education, research and improved access to care. PIA has a related website devoted to parents' interests and needs. [9] Groups that work with Ponseti International include CURE International and A Leg to Stand On (India) and Pehla Qadam [10] (Pakistan).

World Clubfoot Day

World Clubfoot Day was introduced in 2013 by Ponseti International Association, and is celebrated on June 3 every year, commemorating Ponseti's birthday. This date was chosen following the signing of the Iowa Clubfoot Declaration during the 2nd International Clubfoot Symposium held in Iowa City, Iowa, USA, on October 4 – 5, 2012.

The goal of World Clubfoot Day is to raise awareness about clubfoot disability and its prevention using the Ponseti method.

Notes

Related Research Articles

Scoliosis Medical condition of the spine

Scoliosis is a medical condition in which a person's spine has a sideways curve. The curve is usually "S"- or "C"-shaped over three dimensions. In some, the degree of curve is stable, while in others, it increases over time. Mild scoliosis does not typically cause problems, but more severe cases can affect breathing and movement. Pain is usually present in adults, and can worsen with age.

Orthopedic surgery Branch of surgery concerned with the musculoskeletal and bones system

Orthopedic surgery or orthopedics, is the branch of surgery concerned with conditions involving the musculoskeletal system. Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal trauma, spine diseases, sports injuries, degenerative diseases, infections, tumors, and congenital disorders.

Clubfoot Bone development disease

Clubfoot is a birth defect where one or both feet are rotated inward and downward. The affected foot and leg may be smaller than the other. Approximately 50% of cases of clubfoot affect both feet. Most of the time, it is not associated with other problems. Without treatment, the foot remains deformed, and people walk on the sides of their feet. This may lead to pain and difficulty in walking.

Arthrogryposis Medical condition

Arthrogryposis (AMC) describes congenital joint contracture in two or more areas of the body. It derives its name from Greek, literally meaning "curving of joints".

Shriners Hospitals for Children Network of hospitals for children

Shriners Children's is a network of non-profit medical facilities across North America. Children with orthopaedic conditions, burns, spinal cord injuries, and cleft lip and palate are eligible for care and receive all services in a family-centered environment, regardless of the patients' ability to pay. Care for children is usually provided until age 18, although in some cases, it may be extended to age 21.

University of Iowa Hospitals and Clinics Hospital in Iowa, United States

University of Iowa Hospitals and Clinics (UIHC) is an 811-bed public teaching hospital and level 1 trauma center affiliated with the University of Iowa. UI Hospitals and Clinics is part of University of Iowa Health Care, a partnership that includes the University of Iowa Roy J. and Lucille A. Carver College of Medicine and the University of Iowa Physicians group practice.

Foot and ankle surgery is a sub-specialty of orthopedics and podiatry that deals with the treatment, diagnosis and prevention of disorders of the foot and ankle. Orthopaedic surgeons are medically qualified, having been through four years of college, followed by 4 years of medical school to obtain an M.D. or D.O. followed by specialist training as a resident in orthopaedics, and only then do they sub-specialise in foot and ankle surgery. Training for a podiatric foot and ankle surgeon consists of four years of college, four years of podiatric medical school (D.P.M.), 3–4 years of a surgical residency and an optional 1 year fellowship.

The Ponseti method is a manipulative technique that corrects congenital clubfoot without invasive surgery. It was developed by Ignacio V. Ponseti of the University of Iowa Hospitals and Clinics, USA in the 1950s, and was repopularized in 2000 by John Herzenberg in the USA and Europe and in Africa by NHS surgeon Steve Mannion. It is a standard treatment for clubfoot.

Hip dysplasia Joint abnormality

Hip dysplasia is an abnormality of the hip joint where the socket portion does not fully cover the ball portion, resulting in an increased risk for joint dislocation. Hip dysplasia may occur at birth or develop in early life. Regardless, it does not typically produce symptoms in babies less than a year old. Occasionally one leg may be shorter than the other. The left hip is more often affected than the right. Complications without treatment can include arthritis, limping, and low back pain.

University of Iowa Childrens Hospital Hospital in Iowa, United States

University of Iowa Stead Family Children's Hospital formerly University of Iowa Children's Hospital and Children's Hospital of Iowa is a pediatric acute care academic children's hospital located in Iowa City, Iowa. The hospital was founded in 1919 and its current facility, opened in 2017, overlooks the university's football home, Kinnick Stadium. The hospital has 190 inpatient pediatric beds and is affiliated with the University of Iowa Carver College of Medicine. The hospital provides comprehensive pediatric specialties and subspecialties to pediatric patients aged 0–21 throughout Iowa and is one of the only children's hospitals in the region and state. University of Iowa Stead Family Children's Hospital also features the only ACS verified Level 1 Pediatric Trauma Center in the state.

CURE International is a Christian nonprofit organization based in Grand Rapids, Michigan. CURE's efforts are focused on providing medical care to children suffering primarily from orthopedic and neurological conditions. The organization's stated mission is "healing the sick and proclaiming the kingdom of God." The organization operates hospitals in Ethiopia, Kenya, Malawi, Niger, the Philippines, Uganda and Zambia. CURE also operates a pediatric specialty training program called CURE Neuro helping children with hydrocephalus and spina bifida survive and thrive through global partnerships. Since its inception, CURE Neuro has trained 41 surgeons from 23 low- and middle-income countries.

Unlike the flexible flat foot that is commonly encountered in young children, congenital vertical talus is characterized by presence of a very rigid foot deformity. The foot deformity in congenital vertical talus consists of various components, namely a prominent calcaneus caused by the ankle equines or plantar flexion, a convex and rounded sole of the foot caused by prominence of the head of the talus, and a dorsiflexion and abduction of the forefoot and midfoot on the hindfoot. It gets its name from the foot's resemblance to the bottom of a rocking chair. There are two subcategories of congenital vertical talus namely idiopathic or isolated type and non-idiopathic type which may be seen in association with arthrogryposis multiplex congenital, genetic syndromes and other neuromuscular disorders.

Dr. John F. Sarwark is Martha Washington Foundation Professor of Pediatric Orthopedics at Lurie Children's Hospital; Former Head, Pediatric Orthopedic Surgery, Lurie Children’s Hospital; and Professor of Orthopaedic Surgery, Northwestern University's Feinberg School of Medicine in Chicago, Illinois.

University Orthopaedic Center Hospital in Utah, United States

The University Orthopaedic Center is the only full-service specialty center of its kind in the Intermountain West, including services in joint reconstruction, sports medicine, pediatric orthopaedics, spinal disorders, hand, foot and ankle, trauma, musculoskeletal oncology, shoulder and elbow, and physical therapy.

Children's feet are smaller than those of adults, not reaching full size until the ages of 13 in girls and 15 in boys. There are correspondingly small sizes of shoes for them. In poor populations and tropical countries, children commonly go barefoot.

Orthopedic templating is a process wherein surgeons using either acetate templates or digital templates estimate the correct size of the prosthesis to be used in surgery. The biggest educator on the subject has been AO/ASIF. In a study published in the Injury journal published in 1998, 94% of consultants and 100% of trainees felt that planning was important but half, respectively, routinely planned fracture treatment.

Puliyur Krishnaswamy Duraiswami (1912–1974) was an Indian orthopedic surgeon, medical writer and the Director General of Health Services under the Government of India. Besides being a Fellow of the Royal College of Surgeons of England and a founder Fellow of the National Academy of Medical Sciences, he published several articles on orthopedics and was a recipient of Robert Jones Medal and the Presidential Merit Award of the British Orthopaedic Association. The Government of India awarded him the third highest civilian honour of the Padma Bhushan, in 1966, for his contributions to the Medical Science.

David B. Levine American orthopaedic surgeon (born 1932)

David B. Levine is an orthopaedic surgeon, hospital administrator, professor and historian of medicine who has held positions since 1961 at the Hospital for Special Surgery in New York City, New York.

Hope Walks U.S.-based nonprofit organization

Hope Walks, formerly CURE Clubfoot, is a Christian nonprofit organization based in Dillsburg, Pennsylvania, that treats infant clubfoot in developing countries around the world. As of 2019, Hope Walks operates over 130 clinics in 16 countries including Ethiopia, Niger and the Dominican Republic. Since 2006, over 135,000 children have been enrolled in the program for treatment.

Ruth Wynne-Davies

Ruth Wynne-Davies or Ruth Blower (1926–2012) was a British medical doctor and scholar of orthopaedics. She researched and wrote about clubfoot and scoliosis.

References

  1. 1 2 Wilcox, Carol (February 2003). "A healing touch". Iowa Alumni Magazine. Archived from the original on 2007-12-19. Retrieved 2007-12-26.
  2. 1 2 McKee, Jennie (December 2007). "Ponseti method revolutionizes clubfoot care". Bulletin of the American Academy of Orthopedic Surgeons (AAOS Now). 1 (10). Archived from the original on 2009-03-24. Retrieved 2007-12-26.
  3. Cosma D, Vasilescu D, Vasilescu D, Valeanu M (September 2007). "Comparative results of the conservative treatment in clubfoot by two different protocols". J Pediatr Orthop B. 16 (5): 317–21. doi:10.1097/BPB.0b013e32826d18a6. PMID   17762669.
  4. Göksan SB (2002). "[Treatment of congenital clubfoot with the Ponseti method]". Acta Orthop Traumatol Turc (in Turkish). 36 (4): 281–7. PMID   12510061. Archived from the original on 2009-03-27. Retrieved 2008-08-31.
  5. MD Orthopaedics, Inc.
  6. World Health Organization: Retrieved on 2007-12-26
  7. McElroy T, Konde-Lule J, Neema S, Gitta S (2007). "Understanding the barriers to clubfoot treatment adherence in Uganda: a rapid ethnographic study". Disabil Rehabil. 29 (11–12): 845–55. doi:10.1080/09638280701240102. PMID   17577719.
  8. Cooper, D. M.; Dietz, F. R. (October 1995). "Treatment of idiopathic clubfoot. A thirty-year follow-up note". The Journal of Bone and Joint Surgery. American Volume. 77 (10): 1477–1489. doi:10.2106/00004623-199510000-00002. ISSN   0021-9355. PMID   7593056.
  9. "Clubfoot Information for Parents". Ponseti International for the Treatment of Clubfoot Website for Parents. Ponseti International Association. 2009. Archived from the original on 2009-02-27. Retrieved 2009-03-13.
  10. Pehla Qadam

Information about the use of the Ponseti method can be found at these sites: