Originally Released: May, 1998
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Most children with club foot undergo major surgery to correct the problem, although a proven technique developed 40 years ago in Iowa successfully realigns club foot in infants without extensive and costly surgery. Fewer than a dozen orthopedic surgeons in the country currently use this minimally invasive procedure.
One of them is John E. Herzenberg, M.D., an orthopedic surgeon at the University of Maryland's Center for Limb Lengthening and Reconstruction. In the past year, Dr. Herzenberg has used what's known as the Ponseti casting method on 12 of his tiny patients who have congenital club foot.
"The success rate has been a remarkable 100 percent," he says. The procedure is inexpensive, is performed in the doctor's office and eliminates the need for major surgery and hospitalization, Dr. Herzenberg adds. The cost of treatment is about one-tenth of the cost of traditional club foot surgery.
The technique was developed by Ignacio Ponseti, M.D., now age 83, a professor emeritus of orthopedic surgery at the University of Iowa.
"When my first article was published, I thought the club foot treatment question was solved and I went on to research other problems," says Dr. Ponseti. But his less invasive technique did not catch on widely, and now he is on a mission to spread the word.
Club foot is a birth defect that causes a malformation of the bones, joints and muscles. The condition occurs in about one out of every 1,000 newborns and is normally treated shortly after birth with weekly casting.
However, the usual cast methods are only partially successful in realigning the foot, Dr. Herzenberg explains. "Invariably, after undergoing three months of casting, the child still needs major reconstructive surgery at 6 months of age."
Dr. Ponseti devised a method of casting that is most successful when instituted immediately after birth. Dr. Herzenberg adds, however, that he has successfully treated one child who first came to his office at age 7 months.
The Ponseti method involves a specific manipulation and casting performed weekly in the doctor's office for 6 to 8 weeks. At the end of that period, the child undergoes a small surgical procedure under local anesthesia in the doctor's office to lengthen the heel cord. Then, a long cast is applied and kept on for three weeks. After that, children wear a special orthopedic device with a bar separating their feet to keep the feet turned out. This must be worn for two months, and then only at night-time for two years.
"This is an vital aspect of the treatment," Dr. Herzenberg says. "Failure to comply with the bracing regimen can lead to recurrence of the club foot deformity."
Although the Ponseti treatment requires a lot of follow-up care, Dr. Ponseti says the traditional surgical approach demands just as much effort in the months following the surgery, and repeat surgeries are often needed.
Studies spanning more than 30 years have shown that the feet of children treated with the Ponseti technique are just as strong as normal feet. Their feet also are generally more supple, mobile and flexible than feet that underwent major surgery.
About 30 percent of patients treated with the Ponseti method need to have their foot balanced when they are between 2 and 4 years old. Known as tendon transfer surgery, this is a fairly simple procedure that does not stiffen the foot, as would a major reconstructive foot procedure, Dr. Herzenberg says.
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