We're at the clinic today because our baby girl, Jude, was diagnosed through ultrasound
that she had clubfeet. We're trying to go a route that seemed to be successful
without being so scary. Surgery is so scary for little ones.
A Walking Miracle
This is little girl Jude. A pretty little girl.
I'm Jen, nice to meet you.
Well, I'm Dr. Ignacio Ponseti and in the past 10-15 years I have taken care exclusively
of babies with congenital clubfoot.
Clubfoot is the most common birth defect, affecting 1 in 750 children.
If clubfoot is left untreated it is one of the leading causes of disability in developing countries.
It develops in the middle of pregnancy in 16-18 weeks of pregnancy and when the child
is born the foot deformity can be brought back to where it was at 16 or 18 weeks of pregnancy very easily.
The Ponseti Method for Clubfoot Treatment
The Ponseti Method has been practiced here at the University of Iowa for 60 years
since Dr. Ponseti established the method in the 50s.
Clubfoot is a deformity where the whole foot is turned in at birth.
As shown in this model, the Ponseti Method consists of gentle stretching of tendons and ligaments
and then placing the foot in a cast in that corrected position.
We change the cast every 4-7 days and with each cast change you gain a little bit at a time.
If you start the treatment in a newborn and you change the cast every 4 days, the treatment
lasts for about 2 1/2 to 3 weeks and the foot is fully corrected. And what's more important,
it will be fully corrected for the life of the patient.
We didn't know until he was born that he had clubfeet, and the doctors told us that
it was something that could be easily corrected, it was nothing major. And so when he was 4
days old we went to a specialist, and orthopedic surgeon.
Surgery is not a solution for clubfoot. Based on long term followup studies it has been
found that the results can be very bad.
We weren't excited about putting him through another surgery and after I talked to other
parents on the website, and they just said "Before you go schedule another surgery,
just contact Dr. Ponseti".
But every orthopedic surgeon who sees patients and treats it surgically knows that this is
not the way to go. The feet are very stiff, and they are very weak, and they are very painful.
They develop arthritis early, about 20-25 years of age, and so the patients are really crippled.
The Parents
Almost half way there, sweetie!
The parents are very important in the treatment of this deformity because it is so visual.
We came in to see Dr. Ponseti, and they applied the first set of casts that day, and then
they took them off I believe about a week later, and at that moment I knew this was right.
He's doing very well. He's walking, running.
The method requires in many of the patients, clipping of the heel cord to allow full correction of the deformity.
The patient is then placed in a cast for 2 1/2 weeks and after that in
a brace which is essential to prevent relapses.
This is the brace developed by John Mitchell which is very comfortable to the babies
because it's soft. And there are three straps here to hold the foot in place, and the foot is turned out, you see.
When they first get into the brace, they will be in the brace for 23 hours a day for 2-3 months.
After 3 months they will be in them for just nap time and bedtime only.
They're usually kicking one leg at a time, but this way they learn that they can do both.
Allison: A Video Diary
We brought Allison home from China at the age of 34 months knowing that she had bilateral clubfeet,
and my husband and I knew it would be a bit of a challenge to find treatment for her
because in America most children are treated right after birth for their clubfeet,
whereas with Allison, she was almost 3 years old.
After we brought Allison home, we took her to her first appointment, and he looked her
over and felt that her case was severe. He said that he was so concerned about the severity
of her case, he is not very confident that the surgeries are going to take care of things
the way that they should and feels that she may end up being an amputation case,
even after all the treatment we had planned for her.
I just figured the method was named after Dr. Ponseti, and I went ahead and looked up
his phone number and called him. We got our airline tickets and 4 days later
my son, my daughter and I flew out, and we set out for Iowa.
It was like watching this miracle unfold one cast change at a time. Every time they took
the cast off, her foot was in a different position, moving closer and closer to that
goal where we wanted it. And it was so incredible to see...look at you!
My name is Amila Muslim, and I'm from Bosnia, Sarajevo. I was very surprised actually because
always when I wrote "clubfeet" in Google the first thing was Ponseti.
There are now 250 or 300 families on the internet talking to each other and talking to parents
with new babies with the deformity, telling them not to let the doctor operate,
and telling them to find a doctor who has learned my treatment and does it well.
In our country they don't do it good, the treatment of clubfeet, they don't know a
lot about this. The baby didn't cry...it was the first time because at home she always screamed.
We have two doctors from Australia today...
I'm Dr. Geoff Donald, I'm the Director of Orthopedics at the Royal Children's Hospital
in Brisbane, Australia, and the reason that we've come to Iowa is to work with Dr. Ponseti
and to credential ourselves in the use of the method.
It's just absolutely brilliant to think that the child is going to have a relatively
normal foot for the rest of their life, without any surgical intervention.
Hopefully within the near future all clubfoot surgery will stop within Australia.
Ronald McDonald House
We feel really blessed to be at the Ronald McDonald House. In our initial treatment we
did stay at a hotel for a few days before there was room here. It was just very isolating,
and so when we came to the Ronald McDonald House it was very nice to see there are other
families that have children with clubfeet, and to talk about where we were in the process.
In our situation, we have a room, we have a kitchen, and beds. And there are toys and television.
You know the flights here were quite expensive, and I know there are people here that have
come from other countries so that has to be really expensive, so just to know you have
a place like this. And everyone we've encountered have been so friendly and nice.
Global Clubfoot Initiative
It is a great pleasure for me to see this technique spread not only to areas highly civilized
but even to areas where the facilities are less available like in Africa,
where the physician assistants can be taught this technique very easily.
There's great success that Dr. Penny had in establishing this treatment in Uganda.
There's thousands upon thousands of children walking around in the villages
on the top of their feet because they never got care.
Most of East Africa, and now West Africa is being influenced by this technique,
and in India as well, so that many children who had to walk on the dorsum of the foot,
these children now are safe into a normal existence.
The mission of the Ponseti International Association is to improve the treatment of children suffering
from the crippling deformity of clubfoot through education, research, and improved access to care.
Over the last few years, we have developed the International Clubfoot Project.
Reports from different countries demonstrate that the technique is very successful.
In the United States we have a 99 percent correction rate, Malawi 98 percent, Brazil 94 percent,
Turkey 95 percent, India 100 percent, Israel 97 percent.
It is our hope that we can transfer these same results to many other countries.
We are working in partnership with many organizations including World Health Organization, CBM,
Cure International, Aga Khan Hospitals, STEPS, and many others to develop
an international program to eradicate neglected clubfoot around the world.
We went from crying to hoping...from hoping to happiness. Now we don't see this as a problem,
we just see this as a small obstacle. And that's the most important thing
that we need to convey to every other parent around the world. This is not something that is going
to preclude your child to have a normal life.
It's really sad because there are doctors out there that are still using old techniques
and techniques that are not nearly as successful. And this...it's like a miracle.
Whenever we meet families here that have little babies, it's nice to show them how well it turns out.
It is really gratifying to see the change, and to see the happiness of the family,
and most importantly, to know that this kid is going to have a fulfilling life without any limitations.
Kids will be able to play, run, bike, and do actually any kind of sports as they grow up.
Dr. Ponseti thinks that he's going to be absolutely normal, so I have faith in him.
We thank Dr. Ponseti so much for the miracle he's created for our daughter, and for the
miracle he's creating for all these children around the world.
We love him dearly, and he will be forever in our hearts.