Sharing Insights From The Bone And Joint Decade International Clubfoot Symposium

I recently had the opportunity to represent the podiatric community at the Bone and Joint Decade Meeting’s International Clubfoot Symposium in Washington, D.C. This invitation-only symposium was arranged by the Ponseti International Association with a mission to establish a worldwide clubfoot directive. Health care professionals, parents of clubfoot patients, public health officials and non-profit organization representatives from all over the world attended.

A secondary purpose, sadly developed prior to our meeting, was to honor the life and legacy of Ignacio V. Ponseti, MD, who passed away last month at the age of 95.

This meeting was attended by the leading experts in clubfoot treatment. The faculty included Jose Morcuende, MD, PhD, from the United States, as well as Norgrove Penny, MD and Shafique Pirani, MD, from Canada. There were also representatives from Kenya, Uganda, Finland, Mexico, Brazil and Portugal. I was invited to participate because of my work on the Haitian Clubfoot Treatment Program alongside my colleague Kaye Wilkins, MD, from San Antonio, Texas.

One very interesting aspect of the meeting was the presentations by three different sets of parents on their perspective of their child’s clubfoot treatment. Most parents who have a newborn with a congenital deformity have no idea on where to turn or whom to trust with their baby’s care. From a health care provider’s standpoint, I found the parents’ presentations to be enlightening and fascinating. In addition, online clubfoot communities such as Nosurgery4clubfoot (https://health.groups.yahoo.com/group/nosurgery4clubfoot/ ) found on Yahoo! groups are well organized, powerful resources for parents of children with clubfoot.

Each country’s representatives then presented the current landscape for clubfoot treatment using the Ponseti method including the difficulties, advances and results. The faculty presented some astonishing ideas. For instance, in Brazil and Portugal, they use the Ponseti method on much older children than we had previously considered. For example, in one case involving a 16-year-old patient, physicians used the Ponseti method and performed an anterior tibial tendon transfer, and were able to achieve complete deformity resolution.

In presenting the Haiti program, Dr. Wilkins and I spoke of the many difficulties that we have faced in establishing the current five treatment sites countrywide. These difficulties include a lack of supplies, poor documentation, very low tenotomy rates, a lack of post-cast braces, transportation problems for families, earlier detection and treatment, education of health care professionals and new parents, program expansion and a lack of funding.

Even with the difficulties the program and Haiti face, we estimate that we have achieved treatment with disability resolution for greater than 50 percent of the newborns with clubfoot without extensive surgery. This is a victory. However, the battle is not yet won and we press on under the guidance and assistance of the CURE International Worldwide Clubfoot Program.

Remembering Dr. Ponseti

In closing, I would like to speak of Dr. Ponseti for a moment. He is a hero of mine and many others, especially those children who would have suffered from disability had he not stayed the course when everyone considered his innovative ideas “crazy.” Not only did he have to persist against Kite’s method but did so during a time when extensive posterior medial release surgery was considered the treatment of choice for congenital clubfoot deformity. He pressed on with dignity and solid research to back up his method until the medical community finally noticed and realized what a magnificent discovery he had made.

I could not have endured over 40 years of doubt from the rest of the medical community as he did. His efforts were truly amazing. He was also a great guy and I would like to share a short personal story with you about him.

On one of my trips to the University of Iowa, he invited me to eat dinner with him and his wife at a restaurant on campus. We had a splendid time and hit it off. The next evening, he invited me to his home for dinner. I ended up eating pizza and drinking a beer with two amazing 90+ year-olds for an unforgettable evening. They welcomed me into their home and treated me like family.

Dr. Ponseti will surely be missed but his legacy will endure. Rest in peace.