Ponseti International to Expand Clubfoot Treatment Overseas

By Molly Rossiter
Iowa Now

The Ponseti International Association will collaborate with partner organization Management Sciences for Health (MSH) on a two-year, nearly $2 million project to increase access to treatment of clubfoot deformity for thousands of children in Nigeria, Pakistan, and Peru.

Each year, 200,000 children worldwide are born with clubfoot, one every three minutes. There is no known cause for the condition and nearly 80 percent of children born with clubfoot live in impoverished countries, says Jose Morcuende, associate professor of orthopaedic surgery at University of Iowa Hospitals and Clinics and chief medical director of the Ponseti International Association. If untreated, children affected by this condition often grow up unable to walk, go to school, or significantly participate in their communities. They are often cast aside and regarded as useless members of society.

The grant from the U.S. Agency for International Development (USAID), provided through MSH’s Leadership, Management, and Governance Project, will broaden the use and understanding of a low-cost, noninvasive, and highly effective method for treating clubfoot—the Ponseti Method.

This method—created by the late Ignacio Ponseti, M.D., while a faculty member at the UI—involves a series of about five plaster casts and a simple snipping of the heel cord to “train” the foot into normal alignment. Before the Ponseti Method was introduced, surgery was the only alternative, an option which has been unavailable or financially out of reach for most families in underdeveloped countries. In contrast, the Ponseti Method is performed as a series of outpatient visits that do not require a hospital stay. It costs only a fraction as much as surgical treatment and has a much higher success rate (95 percent).

By increasing access to the Ponseti Method in Nigeria, Pakistan, and Peru,Morcuende estimates that this highly effective treatment method will be accessible to an additional 2,400 children in two years—more than four times the number of children in those countries who are currently being treated. The goals of this ongoing project include not only improving the quality of clubfoot treatment but putting the ownership of the Ponseti treatment approach into the hands of each local health care team.

In his 22 years with UI Hospitals and Clinics, Morcuende has taken the Ponseti Method to more than 60 countries in an effort to reach more children and teach the method to medical personnel around the world.

“I’m still training people, and it helps to change one doctor and one clinic at a time,” he says. “But how do you change an entire country? You have to do that through a public health approach, which means institutionalizing high-quality, locally-owned and sustainable treatment within the country’s own health system. This project’s true contribution is to permanently strengthen public health systems for the treatment of clubfoot in these three countries.”