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Who is Dr. Ponseti & What is the Ponseti Method?

Dr. Ignacio Ponseti was a physician who was born in Spain and studied medicine at Barcelona University. When the Spanish Civil War began, he enlisted and served as a medical officer with the Spanish Loyalist army. His job included setting fractures, which would lead him into orthopedics, later in life.

During the war, Dr. Ponseti moved to France and, later, to Mexico, where for two years he was a family doctor. In 1941, Dr. Ponseti moved to Iowa, where he studied orthopedics. He completed his residency at Iowa in 1944 and became a member of the orthopedic faculty at University of Iowa Hospitals and Clinics.

In Iowa, Dr. Ponseti followed up on patients who had been treated years earlier for various orthopedic problems. Because Iowa’s population usually didn’t move much, he could contact patients long after they’d been treated and study their outcomes. During this time, Dr. Ponseti learned that the traditional surgical clubfoot treatment left much to be desired.

In those days, surgery for clubfoot involved cutting ligaments and tendons, which allowed doctors to force the foot into a normal position. However, Dr. Ponseit noticed that surgery resulted in a foot that was, for the most part, inflexible. By the time the patients entered adulthood, their foot was stiff and painful.

Dr. Ponseti began looking at stillborn fetuses with clubfoot to learn more about the abnormality. He concluded that the foot grew normally for the first several weeks of pregnancy, but then twisted for some unknown reason. He studied ligaments, tendons and collagen. Under the microscope, he noticed that ligaments could be stretched gently without any damage.

He theorized that the young cartilage and bone cells of a baby’s deformed foot would respond to manipulation. Dr. Ponseti began applying his treatment of clubfoot theory to patients in the early 1950s. He gently stretched a baby’s medial ligaments, then held the foot in its new position while a plaster cast was applied to the foot and leg.

About a week later, the cast was removed. Using his hands only, Dr. Ponseti applied more gentle traction to further stretch the ligaments. After the application of five to seven casts, the foot would change its alignment and appear normal.

Dubbed "The Ponseti Method," this treatment called for pressure to be exerted on the head of the talus, not the cuboid bone, as was done with another treat "Kite Method." Dr. Ponseti called this "Kite’s mistake." Using his method, Dr. Ponseti concluded that the foot would come back into the normal position, as it was in that position for the first half of the pregnancy.

Although created in the 1950s, the Ponseti Method for clubfoot treatment did not reach a wider audience until it was re-popularized in 2000 by Dr. John Herzenberg. It was also made popular in Europe and Africa by surgeon Steve Mannion. Parents of children with clubfeet also helped the “Ponseti Method” gain wider attention on the Internet.

Science backed up all this enthusiasm. There was a study of the ponseti treatment for clibfoot, from 1991 to 2001, that concluded if the Ponseti Method was correctly done, this treatment of clubfoot was successful in 95% of cases of clubfeet using non- or minimal-surgical techniques.
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