Tag Archive | Ponseti method

Innovation + Persistence: A Crucial Combination

In the 1970s and 80s, the debate regarding management of clubfoot deformity centered around the location of incisions and how aggressive to be with open releases of hindfoot joints. At that time, Prof. Ignacio Ponseti had been working on his conservative method of clubfoot correction for decades, but his technique was relegated to the sidelines and dismissed as being out of the main stream. Yet he persisted in carefully documenting his results, quietly perfecting his methods, and disseminating his technique by teaching other practitioners. Ever so slowly, the pediatric orthopaedic community migrated in his direction as the complications of the other aggressive surgical procedures, including stiff and painful feet, became apparent.

In the May 2, 2018 edition of The Journal,  Zionts et al. report medium-term results from their center with Ponseti’s method. This is a very important study because most of the previously published data regarding mid- to long-term outcomes had come from Dr. Ponseti’s medical center.

The authors found that all 101 patients in the study treated with the Ponseti method had fair to good outcomes at a mean follow-up of 6.8 years. Nevertheless, >60% of the parents reported noncompliance with the bracing recommendations; almost 70% of patients had at least one relapse; and 38% of all patients eventually required an anterior tibial tendon transfer. Increased severity of the initial deformity, occurrence of a relapse, and a shorter duration of brace use were all associated with worse outcomes.

Taken as a whole, the results of this study are comparable to those presented by Ponseti and others from his institution. Even though the Zionts et al. investigation was also  a single-center study, the findings are important considering the widespread use of his technique and limited “external” data confirming the validity of this method.

Dr. Ponseti created and refined a highly impactful technique that yields good outcomes in patients with a difficult problem. Although it took decades for his methods to be widely accepted, the lesson here is that what wins the day are careful documentation, thoughtful attention to how best to teach a method, and persistence in the face of skepticism.

Marc Swiontkowski, MD
JBJS Editor-in-Chief

JBJS On-Demand Webinar–Clubfoot: Predicting and Treating Ponseti Method Failures

jan. webinar speakers.JPG

The Ponseti method is a proven treatment for idiopathic clubfoot, yielding excellent outcomes with minimal pain or disability. However, as many as 40% of patients fail to respond to initial treatment or develop recurrent deformities.

On Wednesday, January 25, 2017 at 8:00 PM EST, The Journal of Bone & Joint Surgery hosted a webinar that delved into two recent JBJS studies investigating how to predict which patients are most likely to get subpar results from the Ponseti method, and how best to manage clubfoot relapses if they occur.

  • Matthew Dobbs, MD, describes in detail various soft-tissue abnormalities present in patients with treatment-resistant clubfoot that are not present in treatment-responsive patients. These parameters could be used to predict which clubfoot patients are at greater risk of relapse.
  • Jose Morcuende, MD, will spotlight findings from a study that followed treated clubfoot patients for 50 years to determine whether relapses managed with repeat casting and tibialis tendon transfer during early childhood prevented future relapses.

This webinar was moderated by James Kasser, MD, surgeon-in-chief at Boston Children’s hospital and a member of the JBJS Board of Trustees. The webinar offered additional perspectives on the authors’ presentations from two clubfoot-management experts—Steven Frick, MD and Gregory Mencio, MD. The last 15 minutes was devoted to a live Q&A session, during which the audience asked questions of all four panelists.

Register now to watch the webinar on-demand!

JBJS Webinar–Clubfoot: Predicting and Treating Ponseti Method Failures

jan. webinar speakers.JPG

The Ponseti method is a proven treatment for idiopathic clubfoot, yielding excellent outcomes with minimal pain or disability. However, as many as 40% of patients fail to respond to initial treatment or develop recurrent deformities.

On Wednesday, January 25, 2017 at 8:00 PM EST, The Journal of Bone & Joint Surgery will host a complimentary webinar that delves into two recent JBJS studies investigating how to predict which patients are most likely to get subpar results from the Ponseti method, and how best to manage clubfoot relapses if they occur.

  • Matthew Dobbs, MD, describes in detail various soft-tissue abnormalities present in patients with treatment-resistant clubfoot that are not present in treatment-responsive patients. These parameters could be used to predict which clubfoot patients are at greater risk of relapse.
  • Jose Morcuende, MD, will spotlight findings from a study that followed treated clubfoot patients for 50 years to determine whether relapses managed with repeat casting and tibialis tendon transfer during early childhood prevented future relapses.

This webinar is moderated by James Kasser, MD, surgeon-in-chief at Boston Children’s hospital and a member of the JBJS Board of Trustees. The webinar will offer additional perspectives on the authors’ presentations from two clubfoot-management experts—Steven Frick, MD and Gregory Mencio, MD. The last 15 minutes will be devoted to a live Q&A session, during which the audience can ask questions of all four panelists.

Seats are limited, so register now!