THE EFFECTIVENESS
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 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.
ANY MODIFICATION INTRODUCED TO THE METHOD—FROM MISUNDERSTANDING IT, THROUGH INCORRECT PROCESSING DURING THE CORRECTION PHASE, TO IMPROPER USE OF THE BRACE—REDUCES THE EFFECTIVENESS OF THE METHOD!
NON-REPEATABILITY
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.
People were falling over themselves to do fancy invasive surgery, and this one strange old guy who speaks softly with a Spanish accent in Iowa was getting sort of ignored by the drumbeat of people who were in favor of surgery
THE QUALITY OF TREATMENT
When the Ponseti method is applied in its entirety and its effectiveness is maintained at a high level, it reaches a point that can be called "quality of treatment", meaning treatment at a very high standard from every perspective. At this point, the Ponseti method can be considered the "gold standard of treatment" in a given country. One can also look at this from the other side – by adopting the Ponseti method as the "gold standard of treatment" for clubfeet, it is possible to achieve proper application and high effectiveness, as seen in some African countries, for example.
The high quality of treatment for children with congenital clubfoot should be the goal that both doctors and medical staff, as well as parents, strive for through mutual collaboration and dialogue based on respect and clear information. If this is lacking, many aspects of the treatment suffer, which affects the accuracy of the Ponseti method, its effectiveness, and, most importantly, the health of children's feet.
THE POWER OF THE INTERNET
Although Dr. Ponseti successfully treated clubfoot deformity without surgery for over 50 years, his method was not initially well received by most orthopedic surgeons. Furthermore, it was criticized, and he himself secluded himself in Iowa, treating many children with remarkable success. Parents whose children were under Dr. Ponseti's care quickly noticed the extraordinary results of the treatment and began sharing them with one another through the fastest means of communication, the Internet. One could say that it was the Internet and the parents who contributed to the widespread adoption of the Ponseti method. Dr. Herzenberg says, "Clubfoot is the true prototype of how the Internet has changed medicine and how parents have become a driving force in many ways." A catalyst for the increasing recognition of the method was the publication of Dr. Ponseti's book (1996) on congenital clubfoot, which Dr. Ponseti – as he himself admitted – wrote thanks to the encouragement of his wife, Helena.
The method is now approved as the "treatment of choice" by most pediatric and orthopedic associations worldwide, meaning that it is consciously chosen by the medical community to treat children with this condition. Most doctors have replaced invasive surgical treatments with the Ponseti method.
Surgeons are trained to operate and usually that's the way they make money. The Ponseti method brings in a lot less for orthopedists.
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!
THE AMERICAN ACADEMY OF PEDIATRICS AND THE WORLD HEALTH ORGANIZATION
HAVE DEFINED THE PONSETI METHOD AS THE "GOLD STANDARD OF TREATMENT"
OF THE CLUBFOOT.
- it is WELL DESCRIBED by the creator himself – DR. IGNACIO PONSETI – with its approach, assumptions, methodology, process, and clear instructions for specific situations
- it has been WIDELY TESTED on a large number of patients of different ages, in many independent centers, and by independently working doctors
- it has been OBJECTIVELY VERIFIED through numerous medical studies based on a large group of patients in many centers and over a long period of time
- it is WIDELY AVAILABLE to patients and doctors and is relatively simple to implement
- it is FAST – bringing the foot to functional condition takes a relatively short time: the average number of casts needed for correction is 5 (changed weekly). This model reduces the time loss associated with long-term treatment, which results in time savings. Furthermore, the feet quickly regain their functional abilities, allowing the child to use them properly in their development
- it is REPEATABLE both in terms of assumptions and process, as well as time: it can be applied to infants as well as older children, adolescents, and adults using repeatable methods and the same components
- it is EFFECTIVE – with the Ponseti method, the number of surgical interventions for feet dropped from 70% (1996) to 10% (2006). This is a significant difference, showing that the application of simple solutions is highly effective and that unnecessary surgeries can definitely be avoided
- it is ECONOMICAL – the use of inexpensive materials reduces costs. One could even assume that the method is low-cost, which is very important in developing countries. Children also do not require highly advanced equipment or orthopedic shoes
- it has LONG-TERM EFFECTS – with proper treatment, monitoring, and vigilance, the feet remain in good condition throughout life. The low recurrence rate compared to the initial treatment shows that children treated with the Ponseti method do not need invasive surgeries because the use of simple actions keeps the feet in a healthy state. Before Ponseti began implementing his method, he observed that many patients treated surgically (posteromedial release, various types of releases, osteotomies) struggled with pain, stiffness, and one surgery led to another. The effects of treatment were not long-term. The quality of life of these patients is incomplete, and the discomfort felt by them far exceeds that of patients with, for example, Parkinson's disease.
- it is APPROVED by many orthopedic associations and medical organizations worldwide.
Always, the least invasive approach will be the best for a person. This has a significant impact on health. This is exactly what the Ponseti method is.
- Ponseti I.V. et al.: „Radical reduction in the rate of extensive corrective surgery for clubfoot using the Ponseti method.”
- Abdelgawad A.A. et al.: „Treatment of idiopathic clubfoot using the Ponseti method: minimum 2-year follow-up.”
- Porecha M.M. 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).”
- Colburn M., Williams M.: „Evaluation of the treatment of idiopathic clubfoot by using the Ponseti method.”
- Herzenberg J.E., Radler C. i inni: „Ponseti versus traditional methods of casting for idiopathic clubfoot.”
- „How Parents And The Internet Transformed Clubfoot Treatment?”
- Herzenberg J.E. et al.: „Worldwide spread of the Ponseti method for clubfoot”
- Percas-Ponseti H.: „Homage to Iowa: The Inside Story of Ignacio V. Ponseti”
- Dobbs M.: „Long-term follow-up of patients with clubfeet treated with extensive soft-tissue release”
- Zionts L.: „Has the rate of extensive surgery to treat idiopathic clubfoot declined in the United States?”
- Morcuende J.A: The Ponseti Methhod as the New Gold Standard.
In the order on the page:
- Dr. John Herzenberg
- Goal
- Others: own