Living legend

Written by Heather Spangler

Photos by John Richard

Ignacio Ponseti developed a non-surgical method of correcting clubfoot in babies in the 1950s.

Today, the 93-year-old is still treating some 100 babies a year and answering 40 e-mails daily from anxious parents and doctors curious to learn how he does it.

The Ponseti method was born out of his research into the long-term outcomes of clubfoot surgeries performed at University Hospitals. He found that many surgical patients experienced pain after adolescence in addition to stiffness later in life. He discovered that the condition, which appears in about 1 in 1,000 births in the U.S. and is characterized by a deformity of the foot that causes it to turn inward, can be better treated with a less invasive method. His method stretches the ligaments and molds the foot into shape using manual manipulations, casts and braces.

“It’s a simple technique based on the understanding of the mechanics of how the joints move,” he said. “Nature has provided us with a great gift. When cutting ligaments and joint capsules, you destroy nature’s way of bringing about normal foot motion.”

Ponseti has treated thousands of babies with his method and has trained doctors around the world to use it as well.

Stuart Weinstein, chairman of the Department of Orthopedics and Rehabilitation at University Hospitals, has been working with Ponseti for 35 years and describes him as his “orthopedic father.”

“He’s a wonderful physician and human being,” he said. “He’s very caring, always looking out for the patients’ interests first.”

Ponseti’s road to Iowa City was rocky. He spent most of his youth in Barcelona, Spain, where his father was a watchmaker. He earned his medical degree from the Universidad de Barcelona in 1936, one day before the Spanish Civil War broke out. Ponseti served as an orthopedic surgeon during the war.

In 1939, anticipating the start of World War II, Ponseti set out for Mexico, where Spanish refugees were granted citizenship. Ponseti served as the only doctor in Juchitepec, a town of 5,000 south of Mexico City. There he battled a typhoid fever outbreak and managed to save all 60 people who came down with the illness.

Ponseti left Mexico in 1941 and traveled to Iowa City by bus to pursue post-graduate studies.

In addition to his difficult path to Iowa, Ponseti has had a difficult time getting the word out about his clubfoot method. He said many surgeons are skeptical about a method that doesn’t involve cutting, and don’t suggest it for their patients as an alternative treatment.

Naomi Davis runs the Ponseti Clinic at Booth Hall Children’s Hospital in Manchester, England. She contacted Ponseti to learn his method after hearing him speak to a surgeons’ convention in 2000.

“Dr. Ponseti stood in front of a huge auditorium full of surgeons and said ‘Clubfoot is not a surgical problem.’ There was a sharp intake of breath from around the room,” Davis said.

Weinstein said the method has gained momentum, especially after Ponseti published a book in 1996, and it finally has become the preferred treatment around the world in the past seven or eight years.

“It’s bittersweet because we’ve known its success here for 60 years, yet it took all this time for it to be accepted world wide,” Weinstein said. “The sadness is that the children for a large portion of time didn’t have the opportunity to have that treatment and many of them had surgeries which we think could have been avoided.”

Jennifer Trevillian’s daughter, Kelly, was born with clubfoot in 2000 and almost missed out on the Ponseti method. Trevillian learned about it online and asked her doctor if it was an option.

“He looked me in the eye and told me not to believe everything I read on the Internet,” Trevillian said. But she wasn’t convinced — she said she wanted to explore her options before consenting to the surgery.

“I was devastated at the prospect of my child undergoing major reconstructive surgery; the thought of surgical pins protruding from my baby’s foot made my stomach turn,” she said. So despite her doctor’s advice, Trevillian and her family traveled from Michigan to Iowa to meet with Ponseti.

“He was very gentle with my daughter and made sure she was relaxed and comfortable,” Trevillian said. “I knew that my daughter was in the right place and the weight was finally lifted from my shoulders. Dr. Ponseti did indeed fix her foot with just four casts and an in-office procedure to lengthen her Achilles’ tendon. When we took the cast off, it was amazing to see her beautifully corrected, flexible foot.”

Eight years later, Trevillian said Kelly is a normal second-grader with a normal looking foot.  “We are forever grateful to Dr. Ponseti, not only for what he’s done for our daughter’s foot, but for his life’s work in improving the lives of children all over the world,” she said. “When you’re around him, you can’t help but to be amazed and inspired by his compassion, dedication, and warm nature.”

Although Ponseti officially retired from University Hospitals in 1984, at age 70, he is still passionate about his work and can be found at the hospital nearly every day. His wife, Helena Percas-Ponseti, is not surprised by his continued interest in his work.

“He is a man who cannot be at rest,” she said. “Going to the hospital and doing what he is doing with the club feet is what relaxes him the most, even though he is exhausted when he gets home. He’s just so happy to see those babies.”

Percas-Ponseti said her husband is thrilled to see his method gaining recognition in the United States and around the world.  “Of course he’s very happy,” she said. “I keep telling him that many people have to die before they are recognized.”