Dr. Ignacio Ponseti dies at 95; invented nonsurgical treatment for clubfoot

Dr. Ignacio Ponseti, a refugee from the Spanish Civil War who created a nonsurgical way of treating clubfoot in infants that prevented a lifetime of disability, died Oct. 18 at the University of Iowa Hospitals & Clinic. He was 95 and had suffered a stroke in his office at the university four days earlier.

“His pioneering work in the treatment of clubfoot changed the lives of tens of thousands of children worldwide, and the training he provided other medical professionals ensures that future generations of children will also be helped,” said Dr. Jean Robillard, vice president for medical affairs of University of Iowa Health Care.

An estimated 200,000 infants worldwide are born each year with clubfoot, in which a tight, deformed Achilles’ tendon causes the foot to turn downward or sideways. Victims walk on the side of the foot or ankle, and the condition is severely debilitating if not corrected.

In 1921, Dr. Arthur Steindler of the University of Iowa developed a surgery to correct the defect. When Ponseti joined the staff 20 years later, Steindler asked him to review the procedure. Ponseti concluded that the surgery often left patients with stiff ankles and a limp, and he began looking for better ways to correct the condition.

He recognized that infants’ foot bones are mostly cartilage, which is relatively malleable. He concluded that gradually stretching ligaments, bones and tendons into the proper position could correct the problem.

“Physicians have been doing manipulation for clubfoot since Hippocrates, but they did not know how the joints moved,” Ponseti said two years ago. “They just tried to smash the bones into position. You have to be able to feel every one of the bones with your hands. It’s a little bit like playing the piano.”

When a child first visited him, Ponseti would gently stretch and tug the foot into a closer approximation of the correct position, then place it in a toe-to-groin cast to hold it in place. The process would be repeated weekly for three to five weeks. Then, the child would be fitted with a brace that he or she -- girls are twice as likely to suffer the problem -- would wear 23 hours a day for three months. After that, the brace would be worn only at night and during naps for three more years.

By age 4, the clubfoot would be corrected, with no lingering problems and at a cost considerably lower than surgery.

Studies showed that the Ponseti method was 98% successful. But outside of Iowa, where a few thousand children were treated, few used the new procedure. “Surgeons love their little knives,” Ponseti lamented to the Chicago Tribune in 2006.

He attempted to spread the gospel with his 1996 book, “Congenital Clubfoot: Fundamentals of Treatment,” but with only limited success.

What really changed attitudes was the advancement of the Internet, which allowed parents of children with the deformity to seek out treatments and spread the word about successes. Parents rejected surgery and sought out practitioners of the Ponseti method.

Bowing to the inevitable, the American Academy of Pediatrics in August 2006 endorsed the Ponseti method and it became the accepted treatment.

Ignacio Vives Ponseti was born June 3, 1914, on the island of Minorca off the coast of Spain. His father was a watchmaker and young Ignacio worked with him during summers, learning a delicacy of manipulation that would be of great value in his medical career.

He studied at the University of Barcelona, completing the requirements for his medical degree in 1936, one day before the start of the Spanish Civil War. Volunteering for the Loyalist army, he spent three years working with the Orthopedic and Fracture Service treating battle wounds.

In 1939, when the fascist army of Gen. Francisco Franco was gaining control of the country, Ponseti decided it was time to leave. But first, he spent three days setting the fractures of 40 patients in his care, then arranged for them to be taken to France through the Pyrenees by mule.

Ponseti made his way to Mexico, where he served as the community doctor for the small town of Juchitepec, south of Mexico City.

After two years, he came to the attention of Dr. Juan Farril of the University of Mexico, who recommended him to Steindler at Iowa.

Ponseti spoke little English and, because of the war, had never formally received his medical degree. But he was able to explain himself -- in French -- to the dean of the university’s graduate program, who helped resolve the problems and bring him to the university.

Ponseti spent the rest of his career at Iowa. He retired in 1984 but returned two years later, treating patients at least three days a week.

The bulk of his career was spent researching and treating clubfoot, but he also studied scoliosis and hip dysplasia and established a connective-tissue laboratory at the university.

He is survived by his wife of 48 years, the former Helena Percas, a Spaniard whom he met in Iowa; a son, Bill of Novato, Calif.; seven grandchildren; and six great-grandchildren.

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