Friday, August 28, 2009


Clubfoot, or, as it is technically called, Congenital Talipes Equinovarus is a birth defect that causes one or both feet to be pointed down, twisted in and curled up, to put it very simply. Sometime I'll post some before and after photos, but at the moment I only have some after.

See these feet? Do you see anything wrong with them? Neither do I! Well, I notice that they are still pointed downward a bit, and this baby will need a simple procedure to release tight tendons. I've been treating him according to something called the Ponseti Method. Ponseti is the doctor who, from 1948 to 1963 developed a way to treat this condition without surgery, by stretching tendons and ligaments, and then placing casts on the feet. About once a week the stretching is repeated and new casts are applied. The rest of the world didn't adopt his method until the 1990s, but it is now considered the standard of care.

I was surprised to learn that Dr. Ponseti is still around! He is 95, and was actively treating kids with clubfoot until this past January, when he fell at home and broke his hip. When he recovered, he started coming once again into the clinic that bears his name, but just do observe, comment and visit. While we were in the US on home assignment a few months ago, I was able to spend 3 days in the clinic there, mostly with Dr. Jose Morcuende, one of Dr. Ponseti's "disciples". I had been learning about the Ponseti Method from books, the internet, occasional visiting orthopedists, and experience, but those 3 days gave me a big "foot up" in my learning! The older gentleman in the photo is Dr. Ponseti, the younger, Dr. Morcuende. The one between the two ages is me.

After completing several weeks of repeated casting (5-6 casts if you're good, and I'm getting better, so I'm getting closer to that ideal), most of the babies need the tendon release. After that, they wear a brace full-time for about 3 months, and part-time for several years. One problem for us here is where to get these braces. The solution has been to make them ourselves. I build them out of a piece of plywood, and baby shoes purchased in the US. I'm really quite satisfied with my present design. By mass-producing the wooden part, I can cut the time required to make one to about 20 minutes.

Here I'm trying a new brace on one of the babies. Another brace in on the table nearby. You can see that the other moms hang around, visit and form an informal "support group" for each other.

This has really become a great source of satisfaction in my work. Look at this last photo, and I think you'll understand.

No comments:

Post a Comment