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|For Immediate Release
Research Shows that Innovative Technique more Successful in Correcting Pediatric Clubfoot
John E. Herzenberg, MD, head of pediatric orthopedic surgery at Sinai Hospital of Baltimore, Maryland, has found that a non-surgical technique, known as the Ponseti Method, has a greater success rate in correcting clubfoot than the traditional casting techniques used by most pediatric orthopedic surgeons. A report on his research was published in the May 2002 issue of Orthopedics Today.
Herzenberg's research also shows that by using the Ponseti Method, extensive surgery can be eliminated in 90% of children with this foot deformity. The full study will be published later this year in the Journal of Pediatric Orthopedics.
The Ponseti Method involves three simple phases: casting, cutting of the Achilles tendon, and special shoes with a bar. First, the technique begins with weekly casting for 5 to 7 weeks until the desired positioning of the heel is achieved. Next the tenotomy, or
cutting of the Achilles tendon, is performed in the doctor's office under local anesthesia and the child is put in a cast for three more weeks. The tenotomy facilitates the final correction. After three weeks, the tendon is healed and children are then fitted for the special shoes connected by a bar, which is worn continuously for the first 3 months, and then only at bedtime until they are two to three years old.
Traditional casting differs from Ponseti in that it typically employees a short cast and does not use the specific Ponseti foot manipulations. As a result, extensive surgery is usually required with this approach.
Standard surgery involves a large incision of up to 6 inches to the back of the calf and ankle and extensive cutting of the joint ligaments and lengthening of the muscles. This causes extensive scar tissue and weakens muscles. There is often a need for repeat surgeries due to the occurrence of over or under corrected feet. In the long run, pediatric orthopedic surgeons are finding that babies treated with extensive surgery often grow up to have stiff, painful and weak feet. The Ponseti Method avoids most of these problems.
Herzenberg's research proves that the Ponseti Method, when followed strictly, has a 95% success rate in correcting clubfoot even in infants as old as 9 months and even for those infants for whom other casting procedures had failed. "This is an opportunity for other pediatric orthopedic surgeons not currently using the Ponseti Method to rediscover a better technique that has a proven success rate and is dramatically less invasive than surgery,” said Herzenberg. As one of the first pediatric orthopedic surgeons in the United States to re-discover the Ponseti Method, Herzenberg is committed to bringing this technique to the forefront of discussion among the pediatric orthopedic community.
However, Herzenberg cautions, "adequate training in the Ponseti technique is the most important factor in revolutionizing the way surgeons deal with clubfoot. Inadequate training or modifications to the technique will not produce the results Dr. Ponseti found and could eventually cause the method to get a bad name.”
The Ponseti Method is named for Ignacio Ponseti, MD, and an orthopedic surgeon from Spain, who developed the procedure. Ponseti began the clubfoot revolution in 1996 with his book, Congenital Clubfoot: Fundamentals of Treatment, which had remained relatively unknown in the pediatric orthopedic circle until only recently. Now in his late eighties, Ponseti still practices medicine and his method for correcting clubfoot at the University of Iowa Hospital.
According to the American Association of Foot and Ankle Surgery, approximately one in every 1,000 newborns has clubfoot, making it one of the most common, non-major birth defects. Clubfoot affects the foot and ankle, causing the heel and toes to twist inward. It may look as if the foot has flipped and the bottom of the foot faces upward. Untreated, these children will have a severe functional disability.