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IGNACIO PONSETI The clubfoot treatment pioneer is changing medicine—and the lives of children around the world.

It’s a clinic day, so flecks of plaster dot the cuffs of Ignacio Ponseti’s white coat. At age 93, Ponseti continues to treat children with clubfoot, carefully straightening their feet with practiced manipulation and a series of plaster casts.

Ponseti pioneered the method more than 40 years ago. But only in the last decade has it gained wide acceptance as a treatment for clubfoot, a congenital condition that twists the feet practically upside down. Today Ponseti’s discoveries save thousands of children from unnecessary, even potentially harmful, surgeries.

“Physicians have been doing manipulation for clubfoot since Hippocrates, but they did not know how the joints moved. They just tried to smash the bones into position,” says Ponseti, professor emeritus of orthopaedic surgery. Surgeons sometimes sever ligaments and tendons in the process, a practice that causes stiffness, arthritis, and other long-term complications.

As a young doctor, Ponseti knew there had to be a better way. He studied stillborn infants with clubfoot, discovered how to manually reshape the feet, and quietly practiced and taught his method.

“He knew it was an important finding, but he was one person telling the rest of the world he could cure these patients with five plaster casts,” says Jose Morcuende, associate professor of orthopaedic surgery. The “Ponseti Method” is now the standard of clubfoot care in over 20 countries, with practitioners around the world.

Ponseti graduated medical school in Barcelona on the eve of the Spanish Civil War, joining the republican forces as a battlefield physician and learning the latest methods for treating fractures with plaster casts. With nationalist victory looming in 1939, he fled to France, migrated to Mexico, and arrived in Iowa City in 1941.

Under the leadership of Arthur Steindler, the University of Iowa orthopaedics department had become one of the nation’s best, offering Ponseti an ideal site to begin his research career. His first projects included follow-up studies of former Iowa patients.

“Among those I contacted were people treated for clubfoot, and they were all very crippled,” Ponseti recalls. “I knew I could not improve on Steindler’s surgery, so I thought I’d better try something else.”

Ponseti found he could reposition the foot to stretch ligaments and remodel immature bones, hold the foot in place with a cast, and repeat the process weekly. After about a month, the foot appeared normal.

“You have to be able to feel every one of the bones with your hands,” Ponseti says. “It’s a little bit like playing the piano.” One need not be a surgeon—or even a physician—to master the method, which makes it all the more valuable in developing countries with high rates of clubfoot.

It’s taken 30 years, but Ponseti’s work has won global attention. He published a book on his method in 1996, and a follow-up study found his patients healthy and happy. Word of the technique also began circulating on Internet message boards.

Ponseti credits parents—especially mothers—for pushing physicians to reconsider clubfoot surgeries. He’s won passionate converts in the medical community as well, high-profile doctors who write him letters lamenting the surgeries they’ve performed.

Ponseti sees patients three days each week, especially those who’ve traveled long distances to meet the man who changed medicine. “He’s very gentle with kids and can talk families through a difficult moment,” Morcuende says. “We both practice the method, but many want to see him. They want to see the legend.”

Note: Dr. Ponseti died on October 18, 2009. He was 95. Link to news release.

Story by Lin Larson; Photo by Tim Schoon

July 30, 2007