When we hear about a new medical breakthrough in the treatment of a congenital deformity, we often assume it involves a highly technical surgical innovation. It is unusual when that breakthrough involves a relatively simple technique, as is the case with the treatment of clubfoot.
Clubfoot is a deformity of the foot and ankle, which is evident at birth. The forepart of the foot is turned inward, sometimes to where the top of the foot is on the bottom. The back of the foot, or ankle, is in a flexed position and there is a high arch. Generally, these abnormalities are rigid to some degree. Clubfoot is seen two to three times more often in boys and one or both feet may be affected. This deformity is seen in approximately one in 1,000 births, making it a fairly common congenital foot problem.
We are still not certain why a clubfoot happens. In some cases there seems to be a genetic influence in that it is sometimes seen in babies whose family members have had a clubfoot. In most instances, however, there is no obvious hereditary link. It’s important to emphasize that a clubfoot is not due to anything that was done by the mother during her pregnancy. Unfortunately, a clubfoot will not “self-correct.” If left untreated, it will become a serious source of disability.
For nearly a century, doctors have used rather extensive surgery to correct clubfoot. By releasing ligaments and tendons, doctors were able to place an immature foot into a more normal position. Unfortunately such surgery led to pain and stiffness by the time the child reached adolescence.
In the early 1950s, Dr. Ignacio Ponseti, a professor at the University of Iowa, discovered that by using a series of specific manipulations using casts, he could gradually and gently stretch the tight ligaments leading to a repositioning of the immature bones of the foot. This technique, referred to as the Ponseti method, proved to be extremely effective with quicker recovery time, reduced pain and better results.
The minimally invasive technique helps preserve normal foot mobility, which is vital to preserving pain-free function of the foot in the long term. And, if treatment is begun by two weeks of age, correction of the foot can be achieved within two months or less. As the child gets older, he or she will be able to participate with their peers in activities including sports.
Originally, the Ponseti method was slow to win acceptance by orthopaedic surgeons who preferred surgery to treat patients with clubfoot. However, beginning in the 1990s renewed interest in the technique emerged due in no small part to a dedicated group of parents using the Internet to spread the word about this option. This minimally invasive technique is now widely practiced to treat infants with clubfoot worldwide.
Dr. Ignacio Ponseti, who has received international recognition for his efforts and has watched his technique rise from obscurity to become successfully implemented in many centers worldwide, recently celebrated his 95th birthday in Iowa.
Dr. Lewis Zionts has been providing pediatric orthopaedic care for more than 20 years and practices the Ponseti clubfoot correction at Los Angeles Orthopaedic Hospital. For more information Dr. Zionts can be reached at (213) 741-8341 or lzionts@laoh.ucla.edu.
