‘Iowa’s gift to the world’

After nearly 80 years, a world-famous University of Iowa doctor’s innovative, non-invasive treatment for clubfoot deformity still stands proud – and will draw some 300 doctors to Iowa City for an international symposium.

This non-surgical, low-risk, affordable procedure for clubfoot, first pioneered in 1948 by the late Dr. Ignacio Ponseti at the UI, has enabled hundreds of thousands of children worldwide to walk, run, and play.

It is often labeled “Iowa’s gift to the world.”

Doctors from some 50 countries will travel to Iowa City June 3-5 to learn more, from places like Mexico and Norway, Brazil and Pakistan, China and Ethiopia.

“Most are doctors already using the Ponseti Method,” Dr. Jose Morcuende told me. “The main purpose is to update physicians on new advances. It’s been at least ten years since we had the last Ponseti International Clubfoot Symposium.”

Dr. Morcuende is a long-term pediatric orthopedic surgeon at UI who worked closely with Dr. Ponseti and

“Doctors come here from all over to get a stamp of approval from Jose.” Cathy Grothe

Managing director for Ponseti International, referring to Dr. Jose Morcuende

Taking Liberties

Richard Hakes Columnist

The late Dr. Ignacio Ponseti, right, developed the world-renowned method of treating clubfoot, which bears his name. Dr. Jose Morcuende, left, trains doctors worldwide in the method and treats clubfoot patients at the UI Stead Family Children’s Hospital.

PROVIDED BY PONSETI INTERNATIONAL

Dr. Jose Morcuende examines the casts of a seven-month-old clubfoot patient from Virginia. Mother and son currently reside at the Ronald McDonald House on the University of Iowa campus while the child continues about six weeks of serial casting.

RICHARD

HAKES/PRESS-CITIZEN

succeeded him in the vital mission of training doctors here and abroad in the Ponseti Method, recognized for an astounding 95 percent success rate when applied correctly.

Clubfoot orrection by casting

Simply stated, the method calls for a series of carefully applied plaster casts that are replaced and adjusted weekly on the feet of babies with clubfoot, gradually straightening them. The children are then fitted with an “Iowa Brace,” which they wear to sleep for the next few years. The brace is made of a nylon bar linking special orthopedic shoes on each end, which keeps their legs apart and properly positioned through the night.

“The Ponseti Method almost always works if you follow the technique,” said Dr. Morcuende.

He said children who undergo surgery instead are often haunted later in life with early arthritis, chronic pain, scarring, joint strain, muscle weakness or other problems.

“Clubfoot surgeries are declining around the world, but not as much as they should,” he said. “Some kids have had 15 surgeries by the time they are 18, and still have pain at age 35.”

Dr. Morcuende has been training doctors in the Ponseti Method for 25 years, traveling to 80 countries for clinics – most of them in developing nations where medical services are limited.

At the University of Iowa, he sees about 25 clubfoot patients a day, three days a week, about half from Iowa and the rest from other states. He says he sees fewer international patients these days because the Ponseti Method is more prevalent.

Cathy Grothe, managing director for Ponseti International, said Dr. Morcuende is the ultimate authority on the method.

“Doctors come here from all over to get a stamp of approval from Jose,” she said.

80-year-old clubfoot patient treated

The newest development in clubfoot treatment is that more adults are using the Ponseti Method. Casting may have to be applied longer and combined with other treatments because adult bones are fully developed and less adaptable, but many patients see improvement.

“Older adults with untreated clubfoot are walking again,” Dr. Morcuende said.

Dr. Zhao Li of China is an innovator who helped expand the Ponseti Method to older children and adults. He’ll be traveling to Iowa City next month.

“Dr. Li actually successfully treated an 80-year-old Chinese woman with clubfoot who had never worn normal shoes,” Dr. Morcuende told me. “She was walking normally in 10 weeks.”

Still, clubfoot remains a tragic health problem and is believed to be the leading cause of childhood disability in developing nations.

A group of doctors from 17 countries has been responsible for updating clinical guidelines for clubfoot that will be studied at the Iowa City symposium. Activities will take place at the Iowa Memorial Union on campus and will include a welcome reception, two days of panel discussions and a gala dinner.

Ponseti is remembered fondly

Dr. Ponseti was the son of a small-town watchmaker in Spain who fled the civil war, settling in Iowa City in 1941 to study orthopedics under Dr. Arthur Steindler to make medical history.

He was a smart, soft-spoken and humble doctor dedicated not only to ridding clubfoot children of their physical misery, but also from the bullying and social exclusion they often suffered as well.

Ponseti’s life was long and productive. He gave the keynote address at the 2007 international clubfoot symposium at age 93. He died two years later and saw patients on the day he died.

All indications are that clubfoot deformity is not going away.

An estimated 200,000 babies are born with clubfoot worldwide each year, about one in every 1,000 births. The Ponseti International Association, headquartered at the Carver College of Medicine Orthopedic Department, reports that the world needs 4,000 Ponseti practitioners actively treating patients − and it is committed to training as many as possible.

Clubfoot Solutions managing director Todd Becker said his growing organization is the global provider for the Iowa Brace. He said since the non-profit was founded in 2013 with help from the Ponseti International Association, it has distributed 150,000 Iowa Braces in more than 100 countries to families in need. The organization promotes World Clubfoot Day on June 3, which coincides with the symposium.

More info can be found at www.clubfootsolutions. org. Dr. Morcuende is delighted that his mentor’s method continues to expand as the gold standard for global clubfoot treatment.

“Dr. Ponseti would be truly amazed with all the doctors worldwide that are working to improve the lives of babies born with clubfoot using his method,” he said. “The 300 people coming to our symposium are truly a testament to his work and the commitment by so many wanting to carry on his legacy.”

Richard Hakes is a longtime freelance columnist for the Iowa City Press-Citizen.

This Iowa Brace booth can be seen at health trade shows in the European Union and Great Britain. Manager Todd Becker says profits from partners allow Clubfoot Solutions to provide free braces to Ponseti programs in low-resource countries.

PROVIDED BY CPRO DIRECT