PonsetisFeat

It's rare for a group of citizens to rally around their doctor to promote his treatments. Over the past 50 years, the enthusiastic network surrounding Ignacio Ponseti has been spreading the word about his medical techniques.

With commendations like "professional and kind," "compassionate and incredibly skilled," "amazingly gentle," and "magical," they describe Ponseti, UI professor emeritus of orthopaedic surgery. The loyalty expressed by generations of his enthusiastic supporters seems well-deserved.

Lori Stime, of Union City, Calif., belongs to the growing number of supporters trying to proactively educate people around the world about the Ponseti Method, a minimally invasive treatment for clubfoot introduced by Ponseti in 1952.

"Doctor Ponseti's gentle technique works wonders for children born with clubfoot," says Stime, in Iowa City during the week of September 2223 to honor Ponseti during a reunion for his patients and their families.

"Just to know that he lies awake at night worrying about all the children who haven't been treated correctly.It's such a pleasure to find a doctor who cares as much about your child as you do," says Stime, whose daughter Annika's clubfoot was successfully corrected by Ponseti.

Ponseti's gentle nature extends to his treatment method. He is a surgeon, yet what makes the Ponseti Method so desirable to many is that it is a nonsurgical alternative.

"It became fashionable in the 1940s and '50s to operate on clubfoot," Ponseti says. "In medical school, the training and the textbooks began highlighting surgery and nothing else.

"But over the years, there hasn't been much follow-up research on these operations," Ponseti continues. "I have found that people who had surgery must often wear boots or insoles due to foot pain as they age. I talked to one person who can't even step out of his bathtub onto the floor because it hurts too much. With the nonsurgical treatment, most patients' feet look and function almost completely normally."

Although teaching people the benefits of his technique has become a struggle against time and tradition for the 86-year-old Ponseti, orthopaedic medicine hasn't always been his passion. Born into a modest family in the Balearic Islands off the coast of Spain, Ponseti grew up in Barcelona and was influenced by that land's strong arts and sciences history. A fine student, he received a scholarship to the University of Barcelona to study general medicine.

In August 1936, one day after his graduation, the Spanish Civil War erupted between Francisco Franco Bahamonde's soldiers and the Spanish Loyalist army. Ponseti volunteered with the Loyalists, and for three years served as a medical officer in the Orthopaedic and Fracture Service, earning the rank of lieutenant, then captain.

Ponseti credits his professor of surgery, J. Trias, and his medical commanders during the war, men like Adolto Ley and Jimeno Vidal, with inspiring him to pursue a career in orthopaedics, and says the conditions they worked under influenced his preference for noninvasive treatment methods.

"I was part of a very good team of well-prepared people," he says. "Every day, we saw the great power of nature as a healer."

Bolstered by Nazi Germany and Fascist Italy, Franco defeated the Spanish Loyalist army in 1939. Stripped of his Spanish citizenship and left penniless, Ponseti fled to France with thousands of other Spanish Loyalists. Within a few months, Mexico began welcoming certain skilled Spanish workers, including engineers, iron workers, and physicians. Ponseti was among those accepted into the country, and before long he was befriended by Juan Farril, professor of orthopaedics at the University of Mexico.

Farril encouraged Ponseti to travel to The University of Iowa to study under Arthur Steindler, a famous orthopaedist for whom the Steindler Orthopaedic Clinic was named. Ponseti had heard of Iowa, since even then the state's health system was well known. In 1941, Ponseti came to Iowa for what he expected to be a temporary stay. He was admitted to the UI residency program, which he completed in 1944.

Afterword, he joined the orthopaedic faculty at University of Iowa Hospitals and Clinics, excited by the opportunity to study the follow-up history of orthopaedic patients treated here through the years.

"It was during this time of research that I saw the pattern in people who had been operated on for clubfoot," Ponseti says. "The results were very bad. I thought I should try to develop a new method."

Ponseti believes the clubfoot deformity happens late in pregnancy, when normal feet become twisted. Designed to begin in the first week or two of life, the Ponseti Method consists of six to eight weeks of manual foot manipulations, toe-to-groin plaster castings, and tenotomy (wherein the heel cord is severed and stretched to its proper length). After the casting period, the child wears shoes attached at the ends to a metal splint to prevent a relapse. The splint is worn full-time for three to four months, then nightly for at least the next two years.

The mildness of this treatmenteven the tenotomy can be done swiftly, with a local anestheticbegs the question, why hasn't the Ponseti Method caught on among doctors and patients everywhere? Becky Cresto, of Boise, Idaho, has a theory: "I think some people see the shoes connected by the bar that children have to wear, and they think it's cruel," she says. "Maybe they're looking for a quick fixwith surgery, you're done in just a couple months."

Stuart Weinstein, professor of orthopaedics, says acceptance of the Ponseti Method by orthopaedic surgeons has been slow because the technique was practiced solely in Iowa for many years, with a limited number of trained practitioners to spread their knowledge.

"Doctor Ponseti's method is gaining acceptance, which is important because it really improves patients' quality of life" he says. "The technique requires a great deal of studying and mentoring. Videotapes have helped considerably, but they weren't around 40 years ago as an instructional tool."

Weinstein says that even today geography plays a key role, since managed care restrictions often mandate that patients stay in their own region for treatment.

Like most of the people committed to raising awareness about the Ponseti Methodthe University of Iowa Health Care web site is laced with passionate testimonialsCresto, whose daughter Eizabella is one of Ponseti's patients, is convinced that all caregivers could learn from Ponseti's example.

"During our first visit, Dr. Ponseti looked at Eizabella's feet and said, 'These are beautiful feet. I think I can fix them.' Never before had we heard her feet referred to as beautifulit melted our hearts."

"I do love caring for children," Ponseti acknowledges. "And it's very rewarding to

be able to tell parents, 'In just two months, your baby's feet will look normal.' It's great to watch their stress go away."

Weinstein, who along with Frederick Dietz, professor of orthopaedics, has worked with Ponseti in the UI orthopaedic department for many years, puts into words the emotions felt by many of the people who have benefited from the doctor's healing touch.

"Dr. Ponseti has always represented the highest ideals of academic medicine. His concerns have always been patient-centered, trying to help children achieve maximal function in the safest, most expedient manner and without undue risk. The long-term results of this treatment method have been well documented. Hopefully this resurgence of interest in the method will help spread the word."