The Passing of a Hero

Yesterday I got on the net to look for some educational material to use with the parents of my clubfoot patients. As some of you know, I have a special interest in treating children with this birth deformity. The method of treatment that I attempt to use, and which has become the "gold standard" of treatment for this was pioneered by Dr. Ignatio Ponseti. When I logged onto the web site of the Ponseti International Association, I saw the notice of his death about a month ago. There is a nice tribute there, as well as links to dozens of obituaries and tributes.

I have known of him for several years, and this past summer I was privileged to spend three days in the clinic that bears his name. I was worried that I wouldn't be able to meet "Papa Ponseti" (as he was known to the small group of his patients who were old enough to call him anything), as I had heard that he was no longer working. He had sustained a hip fracture a few months earlier, and at age 95, it was reasonable to assume that he would be staying close to home.

My first morning there, after about a half-hour of seeing patients with one of his younger colleagues, I came out into the hall, and there he was, a commanding presence, despite his slight build and the bit of stoop brought on by his 95 years, and a recent hip fracture. He was still coming to the clinic every day, although he no longer was directly treating patients. He watched the younger doctors, making occasional comments. Mostly he focused on the patients. The toddlers gravitated to him, standing at his knee, and exchanging stories and observations. They had no trouble understanding his weak voice and heavy Spanish accent.

I had a couple of brief conversations with him, and had my picture taken with him. Then on the second day, he left me a note, asking me to come by his office after his siesta in the afternoon. I hovered near his office, checking frequently to see if the "do not disturb sign" was still there. As soon as it was gone, I knocked. I spent the next hour and 15 minutes listening to his stories and answering his questions about myself, about PNG and about my work here. He gave me a treasure of gifts; teaching materials, practice models, and an autographed copy of his book.

Our conversation touched only briefly on spiritual things. He had felt deeply betrayed when the Catholic Church supported Franco in the Spanish Revolution. He served as a surgeon in the Loyalist Army, eventually evacuating 40 wounded soldiers by mule over the Pyrenees to France, where he continued to work for a time. His path led to Mexico, where he served as a country doctor for 2 years before seeking orthopedic training at the University of Iowa, where he stayed on as a member of the teaching faculty.

Through most of Dr. Ponseti's life, the medical world believed that the only treatment for clubfoot (also known as congenital talipes equinovarus, or just "talipes") was surgery. Dr. P noticed that most patients who had surgery for this problem ended up with stiff, painful, poorly-functioning feet. Through careful study of the biomechanics of the foot, he came to realize that gentle manipulation could correct the problem in nearly 100% of cases. Patients treated this way usually have pain-free, functional feet for the rest of their lives.

In 1948, when he was 34 years old, Dr. Ponseti had the insight that led to the development of his method of treatment. In 1963, when he was 49 years old, he published the definitive paper on the non-surgical treatment of talipes. He retired in 1984 at the age of 70, with very few people recognizing the value of his work. Only the orthopedic surgeons at the University of Iowa, and the ones that they had trained used his method. In 1986 he came out of retirement to work part-time, mostly treating clubfoot.

Then in the early 1990s when he was about 80, two key events changed his life. First, two younger colleagues published a long-term follow-up study of his patients, documenting conclusively the superiority of his method over surgery. Second, the internet happened, and parents seeking alternatives to surgery for their children started learning about The Ponseti Method, and started flocking to Iowa city, where their babies were lovingly and gently treated by this genius. Soon doctors started flocking after them to learn the method. Dr. P's younger colleagues have traveled the world, teaching it to thousands of doctors in dozens of countries.

From about 1994 until he sustained his hip fracture in January of 2009, Dr. Ponseti worked 3 mornings per week, treating children from all over the world in the clinic that is now called "The Ponseti Clubfood Clinic". He treated more patients in most weeks than he had treated per year early in his career.

My interest in the Ponseti Method grew out of necessity, seeing patients here in PNG who had talipes. I learned from books, and from the internet. A couple of years ago I contacted Dr. P by email to ask a couple of questions. I received a very quick and helpful response. Later he invited me to come to Iowa City, and spend time with him in the clinic. After his hip fracture, his work load was assumed by Dr. Jose Morcuende (also a Spaniard, incidentally), who graciously extended the same invitation to me.

I know that the details of Dr. Ponseti's life might not be interesting to everyone, but I just wanted to tell my friends about this great man who has had a great impact on my life and work. He epitomizes many of my cherished values; overcoming adversity, serving others. And, the fact that he did his greatest work in the last 10 years of his long life is a great encouragement to me.

The first picture is a stock photo from the University of Iowa obtained from the web, but it shows Dr. P very much as he was when I visited with him in his office, right down to the book case behind him, and the skeletal model in his hand.

The second is of me with Dr. P and Dr. Morcuende.

The third is one that I took of Dr. P and a little girl that he had treated some years earlier who was in for a recheck.