THE EFFECTIVENESS OF PONSETI METHOD
If Ponseti method is performed correctly, both by the doctor (each, even the smallest modification reduces the effectiveness), and the parent, statistically 92–100% of clubfoot can be healed without the surgical intervention (not including percutaneous Achilles tendon tenotomy, which is a treatment). However, in order to get to such numbers in the statistics, two important things must be clearly distinguished:
THE EFFECTIVENESS OF THE METHOD
The effectiveness of the method assumes no errors in the method, as in itself, or it assumes a margin of error clearly defined and clarified. In the case of Ponseti method, we can say that it is 100% effective, because it does not contain errors in it: it is well described by Ponseti himself, and his successors develop his thought, clarifying more and more new aspects of this method so that it is even more understandable and accessible. The effectiveness of the method may include terminology and its explanation, methodology, the process of the method – its individual stages and the characteristic features and “errors” assigned to them. The user effectiveness is burdened with error from the assumption. In this case, user effectiveness must be divided into two parts:
- doctor to talk about the high effectiveness of the Ponseti method in relation to doctors, it would be necessary to isolate a group that will apply the Ponseti method perfectly, so understand it correctly (assumptions, terminology, rules), taking into account all possible expected treatment options, all details during the diagnosis, plastering, tenotomy, plaster application in hypercorrection, until the moment the bar is put on, what should also be properly adjusted by the doctor. Absolutely no modification can take place here.
- parent to talk about the effectiveness of the Ponseti method, each parent would have to be highly aware of the treatment of his child, would have to follow the doctor’s recommendations ideally without any changes on his part, whether in the number of hours of using the bar during the day, or in relation to its setting by the doctor.
EACH MODIFICATION WHICH IS INTRODUCED TO THE METHOD: STARTING FROM ITS MISUNDERSTANDING, THROUGH AN INCORRECT PROCESSING OF THE CORRECTION STAGE, ENDING ON THE INCORRECT APPLICATION OF THE BAR, REDUCES THE EFFECTIVENESS OF THE METHOD !
If the treatment is not reproducible, so the same procedures are not applied to the treatment, the Ponseti method cannot be considered as effective. Moreover, statistics cannot be made because they will not be meaningful or reliable. This kind of treatment is pointless. It also deprives children of the possibility of using their own feet, which are elastic, flexible, functional and without surgical intervention, which are still common, and which could be successfully abandoned if knowledge and awareness were prioritized in the treatment of children with clubfoot. Working with doctors around the world who treat with the Ponseti method, we have noticed that despite the passage of years and the increase in their experience, and constantly following the knowledge, they are still repetitive, performing or improving the same procedures. This guarantees them a high level of treatment. Unfortunately, this level decreases when parents do not want to take an active part in treating their children by acquiring the knowledge and awareness, presenting difficult topics to the doctors that require answers or, in a way, mobilizing their doctors to develop.
If the Ponseti method is so successful, why it is not commonly used? Conservative approach to the medical knowledge, caution towards “new things”, lack of willingness to develop and acquire the knowledge, inability, misunderstanding of the method … the answers to this question may be very numerous. This question is answered most accurately by a doctor who – as he says about himself – was against the Ponseti method, considering it “fun” and “condemning” children’s feet to surgery: because it was faster, easier and profitable. Until a certain point, when he saw with his eyes that the Ponseti method is an amazing tool for repairing small feet, leading to full functionality and not bringing multiple complications.
THE QUALITY OF TREATMENT
When the application of the Ponseti method in all its extent is achieved and the effectiveness of this method is maintained and high, it enters the level of what can be called “quality of treatment“, that is, treatment at a very high level from every perspective. Then it can be considered that the Ponseti method is the “gold standard of treatment” for a given country. You can also try to look at it from the other side – by adopting the Ponseti method as the “gold standard of treatment” for clubfoot, you can apply it correctly and achieve high effectiveness, as exemplified by some African countries. High-quality treatment of children with congenital clubfoot should be a goal that both doctors and medical staff as well as parents strive for, through mutual cooperation and dialogue based on respect and clarity of information. If this is missing, many aspects of treatment fail, which affect the correctness of the Ponseti method, the effectiveness and, above all, the health of children’s feet.
THE POWER OF THE INTERNET
Although Dr. Ponseti has successfully treated clubfoot without surgery for over 50 years, his method has not been favorably received by most orthopedic surgeons. What’s more, it was criticized, and he hid himself in Iowa, treating many children with it with amazing results. Parents, whose children were cared for by Dr. Ponseti, quickly noticed the remarkable results of the treatment and began to share them among themselves using the fastest medium – the Internet. It can be said that it was the Internet and the parents who contributed to the spread of the Ponseti method. Dr. Herzenberg says, “Clubfoot is a real prototype of how the Internet changed medicine and how parents became a driving force in many ways.” The catalyst for an increasingly well-known method was the publication of Dr. Ponseti (1996) about congenital clubfoot, which Dr Ponseti – as he himself admitted – wrote thanks to the encouragement of his wife – Helena.
This method is approved as the “treatment of choice” by most pediatric and orthopedic associations worldwide, what means that it is consciously chosen by the medical community to treat children with the defect. Most doctors have replaced invasive surgery with the Ponseti method.
THE AMERICAN ACADEMY OF PEDIATRY AND THE WORLD HEALTH ORGANIZATION HAS DESCRIBED PONSETI METHOD AS THE “GOLDEN STANDARD OF TREATMENT”.
THE GOLDEN STANDARD
Why is Ponseti method called the “golden standard of treatment”? Because it does not use advanced means to achieve the goal – it allows the foot to return to its proper functioning, flexibility and appearance non-invasively. Thanks to the use of uncomplicated medications, it can be an effective treatment where many orthopedic doctors and physiotherapists are missing, and where they are, it points to a non-radical and highly promising treatment for clubfoot deformity without harming the health of children’s feet!
- it is EFFECTIVE – using the Ponseti method, the number of surgical interventions on the feet decreased from 70% (1996) to 10% (2006). This is quite a significant difference, showing that the use of simple solutions is highly effective and that unnecessary operations can be avoided in this way.
- it is FAST – it takes relatively little time to get the foot to it’s functionality: the average amount of casts needed to obtain the correction is 5 (changed every week). Such a model reduces the time wasted on long-term treatment, which is associated with time savings. Moreover, the feet quickly gain their functional capabilities, what allows the child to use them correctly in his development.
- it is ECONOMICAL – the use of inexpensive materials reduces the costs. It can even be assumed that the method is low-cost, what is very important in developing countries. Children also do not need very advanced equipment or orthopedic shoes.
- it has LONG-TERM EFFECTS – with proper treatment, monitoring, vigilance, feet stay in good condition for the whole life. The small number of relapses compared to the initial treatment shows that children treated with the Ponseti method do not need invasive surgery because simple measures keep the feet well. Before Ponseti started implementing his method, he observed that many patients treated surgically (posteromedial release, all types of relief, osteotomies) had pain, stiffness, and the one operation caused the others behind it. Treatment effects are not long-term. The quality of life of these patients is incomplete and the feeling of lack of comfort is much greater than in patients suffering from, for example, Parkinson’s disease.
The least invasive will always be best for a human. This is a great importance for health. That what it is the Ponseti method.
RESEARCHES & STUDIES:
1. Ponseti I.V., Morcuende J.A. et al.: “Radical reduction in the rate of extensive corrective surgery for clubfoot using the Ponseti method.”
2. Abdelgawad, Atefa A. et al.: “Treatment of idiopathic clubfoot using the Ponseti method: minimum 2-year follow-up.”
3. Porecha M.M., Parmar D.S. et al.: “Mid-term results of Ponseti method for the treatment of congenital idiopathic clubfoot–(a study of 67 clubfeet with mean five year follow-up).”
4. Colburn M., Williams M.: “Evaluation of the treatment of idiopathic clubfoot by using the Ponseti method.”
5. Herzenberg J.E., Radler C. et al.: “Ponseti versus traditional methods of casting for idiopathic clubfoot.”
6. “How the parents and the Internet transformed clubfoot treatment?”
7. Golden treatment
8. Herzenberg J.E. et al.: “Worldwide spread of the Ponseti method for clubfoot”
9. Percas-Ponseti H.: “Homage to Iowa: The Inside Story of Ignacio V. Ponseti”
10. Dobbs M.: “Long-term follow-up of patients with clubfeet treated with extensive soft-tissue release”
11. Zionts L.: “Has the rate of extensive surgery to treat idiopathic clubfoot declined in the United States?”
12. Morcuende J.A: The Ponseti Methhod as the New Gold Standard.