Fuente: http://www.nytimes.com/2009/10/24/health/research/24ponseti.html
Ignacio Ponseti, Hero to Many With Clubfoot, Dies at 95
Dr. Ignacio V. Ponseti, an orthopedist whose gentle, nonsurgical method of correcting clubfoot has become the global standard for treatment, helping thousands of children to walk, died Sunday in Iowa City. He was 95.
Susan McClellen/University of Iowa
Dr. Ignacio V. Ponseti using a skeletal model of a foot to explain his clubfoot treatment method.
University of Iowa Department Of Orthopedics and Rehabilitation
Dr. Ponseti's method involved gentle manipulation and the use of casts, shown here.
The cause was a stroke he suffered Tuesday while working in his office, said Tom Moore, a spokesman for theUniversity of Iowa, where Dr. Ponseti taught and practiced.
Dr. Ponseti came up with his method after realizing that surgery for clubfoot actually did harm. Drawing on his experience tending to the wounded in the Spanish Civil War, he found that a regimen of plaster casts, braces and manipulations by hand could avoid the costs and aftereffects of surgery.
Nearly 200,000 children are born every year with clubfoot, a vast majority of them in developing countries. The condition is a birth defect in which the feet are twisted down and inward, making them look like golf clubs with the club heads turned to face each other. It can affect one or both feet. Without treatment, the afflicted appear to walk on their ankles or the sides of their feet.
In the early 1940s, Dr. Ponseti’s research showed that the most common treatment, surgery, could leave a child with stiff ankles and a limp. His alternative involved slowly and gradually straightening and rotating each twisted foot toward its normal position.
The method was applied in stages. After each treatment, he would immobilize a child’s leg with a toe-to-groin plaster cast. A week later, he would remove the cast and shape the malleable foot a bit more, then replace the cast. The treatment would last three to five weeks.
The child would wear a special brace 23 hours a day for three months and then, for two or three years, limit its use to overnight and nap time.
Though Dr. Ponseti devised his treatment a half-century ago, it became popular only in the 1990s, when parents of afflicted children spread word about it over the Internet. Orthopedists found themselves responding to requests for the Ponseti method rather than ordering surgery.
The procedure cures clubfoot in more than 95 percent of cases, said Dr. Jose Morcuende, director of the Ponseti Clubfoot Center at the University of Iowa, citing 25 papers over the last eight years. Dr. Morcuende said a study soon to be published would show that the incidence of surgery for clubfoot had declined 90 percent over the last five or six years, as doctors switched to the Ponseti method.
The method has been endorsed by the World Health Organization, the National Institutes of Health and the American Academy of Pediatrics.
Dr. Wallace B. Lehman, chief of pediatric orthopedic surgery at N.Y.U. Hospital for Joint Diseases, said in an interview Wednesday that the method had “saved countless, countless feet of crippled babies.” In 2001, Dr. Lehman named his hospital’s clubfoot treatment center for Dr. Ponseti.
Dr. Ponseti brought an unusual background to his trailblazing medical work. He thought his delicate touch might have come in part from his youth in Spain, where he worked with his father, a watchmaker, in Barcelona. Later, as a surgeon for the government forces battling the Franco rebellion in the Spanish Civil War, he treated as many as 4,000 wounded soldiers, many with broken bones.
Ignacio Vives Ponseti was born on Minorca, an island off Spain’s Mediterranean coast, on June 3, 1914. His family moved to Barcelona when he was 8. He recalled seeing Picasso’s art and hearing Casals’ cello there. In 1936, he graduated from the University of Barcelona medical school a day before the Spanish Civil War started. Two days later he joined the Republican Army as a surgeon.
After Franco gained control of the fighting in 1939, Dr. Ponseti escaped to France, but only after working for three days to set the fractures of 40 wounded soldiers. With the help of local smugglers, he transported the 40 by mule over the Pyrenees. Penniless, he found his way to Mexico, where he became a village doctor.
Dr. Ponseti went to the University of Iowa in 1941 after a Mexican orthopedist had referred him to the chairman of its orthopedics department. His residency was in orthopedics, and clubfoot quickly became a major interest.
In one research project, he studied outcomes of clubfoot surgery over a 20-year period. After finding that surgery had rarely left a child without impairments, he pondered less invasive treatments, testing them with infants in his clinic.
He seemed to have special gifts, particularly an ability to visualize the interior of a foot and ankle by feeling with his hands. “It’s a little bit like playing the piano,” he said.
Dr. Lehman called the technique “arty” and “counterintuitive,” declaring, “The ordinary surgeon can’t do it.”
But it can be taught, and Dr. Lehman himself was teaching it when he paused to be interviewed by telephone from Israel while on a trip to the Middle East. Dr. Lehman had brought with him six of the flexible acrylic models that Dr. Ponseti developed and was providing them to doctors, Jordanians and Palestinians among them, to practice on. All but five models had disappeared, a “theft” that Dr. Lehman heartily applauded.
Dr. Morcuende, of the University of Iowa, said 80 percent of clubfoot cases were in developing countries, many in Africa. Because doctors are in short supply in those countries, medical technicians there are being trained in the treatment, he said.
By the 1990s, Dr. Ponseti and his colleagues had treated more than 2,000 cases of clubfoot. But he was frustrated that although his method had long before been described in medical journals, more doctors were not using it.
Part of the reason, Dr. Lehman said, was that there had been other manipulation and casting methods, many manifestly ineffective. In an interview with The Chicago Tribune in 2006, Dr. Ponseti offered a more cynical explanation. “Surgeons love their little knives,” he said.
So Dr. Ponseti put his story out, in many ways. He held teaching clinics all over the world and wrote a book, “Congenital Clubfoot: Fundamentals of Treatment” (Oxford, 1996). He helped found the Ponseti International Association for the Advancement of Clubfoot Treatment, whose Web site became an important source of knowledge. Scores of doctors went to Iowa City to learn at his side.
And the tide turned. At Iowa, the number of children arriving for treatment increased tenfold, to 150 a year. Orthopedists elsewhere picked up the procedure.
With the news of Dr. Ponseti’s death, parents have expressed gratitude and condolences on the Ponseti association’s Web site, www.ponseti.info. Earlier, Dr. Ponseti said he had been touched by a gift they gave him: a T-shirt with the footprints of babies whose clubfeet he had cured.
A version of this article appeared in print on October 24, 2009, on page A19 of the New York edition.
Wilmer Ramírez - August 3, 3:13 PM
