The University of Iowa community lost a colleage and friend when Dr. Ponseti died of a sudden illness on Sunday; he was 95. Dr. Ponseti developed a groundbreaking treatment for clubfoot using only casting and braces, not surgery, to train the foot into normal alignment. He persevered in his work even when the orthopaedic community disregarded his findings; through peer-reviewed research the Ponseti method has been shown to have a success rate of nearly 98 percent without the risks of a surgical procedure (the method is also inexpensive and popular in poorer areas of the world). Dr. Ponseti’s method was championed by parents, eventually culminating in founding of The Ponseti International Association in 2006 at the University of Iowa.
Ignacio Ponseti, MD, whose pioneering, non-surgical, low-cost clubfoot treatment has benefited hundreds of thousands of children worldwide, died today at University of Iowa Hospitals and Clinics in Iowa City, Iowa, at age 95 following a sudden illness. Ponseti’s gentle methods and soft-spoken compassion were a hallmark of a six-decade commitment to helping children, and belied a sometimes tumultuous, even dangerous, early career in medicine.
Ponseti was born in 1914 on the Spanish island of Minorca. As a teenager, he worked summers in his watchmaker father’s repair shop. Hours spent learning to make and replace tiny, delicate watch parts were lessons in patience and precision that would serve him well in the years that followed.
Ponseti entered medical school in Barcelona in 1930 and completed his degree in 1936, just before the start of the three-year Spanish Civil War. Volunteering to serve as a medical officer with the Loyalist army, he spent the war in the Orthopedic and Fracture Service treating battle wounds. By 1939, General Francisco Franco’s fascist army had gained control, and Ponseti, fearing imprisonment or worse, chose to leave Spain.
His escape was not a solo effort, however. Ponseti also arranged a risky evacuation for the nearly 40 wounded men in his care. He worked for three days and nights to set their fractures, and then, with the help of local smugglers, he transported the wounded by mule over the Pyrenees mountains to safety in France.
Finding himself with no home or citizenship, Ponseti left France for Mexico, where he served as the community doctor for Juchitepec, a small town south of Mexico City. There, he successfully treated typhoid patients with hydration and bean puree.
While in Mexico for two years, Ponseti met Dr. Juan Farril, a professor of orthopedics at the University of Mexico who had trained in the United States. With Farril’s assistance, Ponseti arranged to study with Dr. Arthur Steindler, then chairman of orthopedics at the University of Iowa. In 1941, Ponseti moved to Iowa City.
Ponseti’s limited English and lack of a medical school diploma (due to the outbreak of the Spanish Civil War) almost stymied his entry into Iowa’s residency program. Fortunately, he was able to explain the situation – in French – to Carl Seashore, then dean of the UI Graduate College, who helped resolve the problem.
After completing his residency in 1944, Ponseti joined the orthopedics faculty at UI Hospitals and Clinics, where he remained for the next four decades treating patients, teaching and conducting research. He retired as professor emeritus in 1984, but returned to the University in 1986 to a consultative practice in orthopedics until he fell ill last Tuesday (October 13, 2009).
Ponseti’s work on clubfoot started very early in his UI career in the 1940s. It was obvious that without treatment, children with clubfoot faced a lifetime of debilitation, and even possible amputation. But the surgical treatments used at the time had significant limitations. With nearly 200,000 children born each year with the condition, the need to find a more effective treatment was imperative.
During his first year as a graduate fellow, Ponseti reviewed the outcomes of Dr. Steindler’s clubfoot surgical treatment used between 1921 and 1941. Analysis showed that surgical treatment often resulted in stiff, fixed ankles. Moreover, although the treated children could walk, they almost always had a limp.
Ponseti’s extensive examination of the anatomy and biology of infant feet, led him to believe that physical manipulation and casting might be a more successful approach. In 1950, Dr. Carroll Larson, head of orthopedics at the University of Iowa, put Ponseti in charge of the clubfoot clinic, where he developed the eponymous method that would slowly but surely revolutionize clubfoot treatment.
Known as the Ponseti method, it involves the careful manipulation of muscles, joints and ligaments held in a series of casts and braces to reposition the foot back to normal. It has become the “gold standard” for clubfoot treatment, after decades of positive follow-up results and numerous international peer-reviewed studies showing success rates as high as 98 percent.
However, for the first 40 years after developing the technique, only Ponseti and a handful of orthopedic surgeons used the method, treating more than 2,000 children. Frustrated by the under-use of his technique, Ponseti and colleagues who had used the technique began making a concerted effort in the 1990s to communicate the method and its successful results to as wide an audience as possible.
Ponseti’s book, “Congenital Clubfoot: Fundamentals of Treatment,” published by Oxford University Press in 1996, describes his experience with the method and includes patient studies confirming the success of the approach. A string of peer-reviewed articles, including multi-decade follow-up studies, also helped raise awareness and professional acceptance of the method.
By early 2000, the Web became an effective grass-roots medium, especially among the parents of successfully treated children who advocated the Ponseti method to other families searching for the best treatment for clubfoot. Over the past decade, these educational and advocacy efforts have resulted in the Ponseti method being considered the mainstream treatment for clubfoot in North America today. The technique is increasingly used to help children with clubfoot from underdeveloped regions of the world. In August 2006, the American Academy of Pediatrics endorsed the Ponseti Method.
Even though he was in his eighties and nineties, Dr. Ponseti continued to train physicians in his method, many of whom came from around the world to learn the technique. You could see the gaggle following Dr. Ponseti down the hallway. Dr. Ponseti’s 1996 textbook, Congenital Clubfoot: Fundamentals for Treatment, has recently been reprinted. In 2006, Helena Percas-Ponseti, herself a professor emeritas of Spanish literature, wrote Homage to Iowa: The Inside Story of Ignacio V. Ponseti, a biography of her husband. I have a copy of this book, signed by both Dr. Ponsetis, on my bookshelves at home.
Rest well, Dr. Ponseti, you gave hope and happy life to so many.