Oct. 19, 2009
NOTE: This version corrects references to the number of children treated by
UI leaders reflect on legacy of Ignacio Ponseti, clubfoot treatment pioneer
University of Iowa leaders today remembered the lasting legacy of Ignacio Ponseti, M.D., University of Iowa professor emeritus of orthopaedics, whose pioneering non-surgical, low-cost clubfoot treatment has benefited tens of thousands of children worldwide. Ponseti died Sunday afternoon, Oct. 18, at University of Iowa Hospitals and Clinics, following a sudden illness. He was 95.
Just days before his death, Ponseti was at work in his university office. His gentle methods and soft-spoken compassion were a hallmark of a six-decade commitment to helping children, and belied a sometimes tumultuous, even dangerous, early career in medicine.
"Dr. Ponseti was a tireless leader with great passion for his field," said Jean Robillard, M.D., vice president for medical affairs with UI Health Care. "His pioneering work in the treatment of clubfoot changed the lives of tens of thousands of children worldwide, and the training he provided other medical professionals ensures that future generations of children will also be helped. He truly personified the UI Health Care vision of world-class people and world-class medicine for Iowa and the world."
The fruits of his efforts
Although he retired in 1984, Ponseti returned to work in 1986 in consultative practice and continued to treat patients, teach and conduct research.
His greatest accomplishments came in the ensuing decades as the clubfoot treatment that he developed and bears his name, the Ponseti method, became widely accepted and used worldwide, thanks in great part to the outreach efforts by families of children he and colleagues had treated at the UI.
"Dr. Ponseti was my mentor, colleague and friend; truly my orthopedic father," said Stuart Weinstein, M.D., UI professor of orthopaedics, who had worked with Ponseti since 1973.
"Personally it's a great loss for me and all of us who trained and worked with Dr. Ponseti, but through his students, his legacy will continue; we have that obligation. The entire university community can take pride in all he achieved," said Weinstein, who also holds the Ignacio V. Ponseti Chair of Orthopaedic Surgery.
A passion for science
Ponseti also devoted his time and intellect to advance basic research behind deforming diseases such as scoliosis, clubfoot and hip dysplasia. He established the first connective tissue biochemistry lab dedicated to this effort.
Ponseti's research into collagen chemistry opened up the field of cell and molecular research in connective tissues, said Jody Buckwalter, M.D., professor and head of the Department of Orthopaedics and Rehabilitation who holds the Arthur A. Steindler Chair in Orthopaedic Surgery.
"In his more than six-decade career, Dr. Ponseti was a role model for compassionate patient care but also for seeking a deeper understanding of the causes of deformities in children," Buckwalter said. "He'd often come into the office with a new idea for studying a genetic defect, for example, that might be responsible for clubfoot. He had an inspiring passion for science, and using science to improve treatment of children."
Formative years in Spain
Ponseti was born June 3, 1914, on the Spanish island of Minorca. As a teenager, he worked summers in his watchmaker father's repair shop, learning skills of precision and developing patience that would serve him well in the years that followed.
Ponseti entered medical school in Barcelona in 1930 and completed his degree in 1936, just before the start of the three-year Spanish Civil War. Volunteering to serve as a medical officer with the Loyalist army, he spent the war in the Orthopedic and Fracture Service treating battle wounds. By 1939, General Francisco Franco's fascist army had gained control, and Ponseti, fearing imprisonment or worse, chose to leave Spain.
His escape was not a solo effort, however. Ponseti also arranged a risky evacuation for the nearly 40 wounded men in his care. He worked for three days and nights to set their fractures, and then, with the help of local smugglers, he transported the wounded by mule over the Pyrenees mountains to safety in France.
A refugee makes a career
Finding himself with no home or citizenship, Ponseti left France for Mexico, where he served as the community doctor for Juchitepec, a small town south of Mexico City. There, he successfully treated typhoid patients with hydration and bean puree.
While in Mexico for two years, Ponseti met Dr. Juan Farril, a professor of orthopedics at the University of Mexico who had trained in the United States. With Farril's assistance, Ponseti arranged to study with Dr. Arthur Steindler, then chairman of orthopedics at the University of Iowa. In 1941, Ponseti moved to Iowa City.
Ponseti's limited English and lack of a medical school diploma (due to the outbreak of the Spanish Civil War) almost stymied his entry into Iowa's residency program. Fortunately, he was able to explain the situation -- in French -- to Carl Seashore, then dean of the UI Graduate College, who helped resolve the problem.
After completing his residency in 1944, Ponseti joined the orthopedics faculty at University of Iowa Hospitals and Clinics, where he remained for the next four decades treating patients, teaching and conducting research. He retired as professor emeritus in 1984, but returned to the university in 1986 to a consultative practice in orthopedics, working until the week he died.
Developing the Ponseti method
Ponseti's work on clubfoot started very early in his UI career in the 1940s. It was obvious that without treatment, children with clubfoot faced a lifetime of debilitation, and even possible amputation. But the surgical treatments used at the time had significant limitations. With nearly 200,000 children born each year with the condition, the need to find a more effective treatment was imperative.
During his first year as a graduate fellow, Ponseti reviewed the outcomes of Steindler's clubfoot surgical treatment used between 1921 and 1941. Analysis showed that surgical treatment often resulted in stiff, fixed ankles. Moreover, although the treated children could walk, they almost always had a limp.
Ponseti's extensive examination of the anatomy and biology of infant feet, led him to believe that physical manipulation and casting might be a more successful approach. In 1950, Dr. Carroll Larson, then head of orthopedics at the University of Iowa, put Ponseti in charge of the clubfoot clinic, where he developed the eponymous method that would slowly but surely revolutionize clubfoot treatment.
The Ponseti method involves the careful manipulation of muscles, joints and ligaments held in a series of casts and braces to reposition the foot back to normal. It has become the "gold standard" for clubfoot treatment, after decades of positive follow-up results and numerous international peer-reviewed studies showing success rates as high as 98 percent.
However, for the first 40 years after developing the technique, only Ponseti and a handful of orthopedic surgeons used the method, treating more than 2,000 children. Frustrated by the under-use of his technique, Ponseti and colleagues who had used the technique began making a concerted effort in the 1990s to communicate the method and its successful results to as wide an audience as possible.
Raising global awareness, with the help of parents
Ponseti's book, "Congenital Clubfoot: Fundamentals of Treatment," published by Oxford University Press in 1996, describes his experience with the method and includes patient studies confirming the success of the approach. A string of peer-reviewed articles, including multi-decade follow-up studies, also helped raise awareness and professional acceptance of the method.
By early 2000, the Internet became an effective grass-roots medium, especially among the parents of successfully treated children who advocated the Ponseti method to other families searching for the best treatment for clubfoot. In particular, a Yahoo listserv started in 1999 by Teresa McLaughlin, whose son Jakob had been treated by Dr Weinstein with the Ponseti method, was critical in spreading the word of the method to families who could benefit from it.
Over the past decade, these educational and advocacy efforts have resulted in the Ponseti method being considered the mainstream treatment for clubfoot in North America today. The technique is increasingly used to help children with clubfoot from underdeveloped regions of the world. In August 2006, the American Academy of Pediatrics endorsed the Ponseti method. In addition, the Ponseti International Association for Advancement of Clubfoot Treatment, founded in 2006 at the UI, is devoted to clubfoot education, research and improved access of care, including helping health care professionals learn about and adopt the method.
Ponseti is survived by his wife, Helena Percas-Ponseti, whom he married in 1960 in Iowa. Dr. Ponseti shared a love of art with his wife, who was originally from Spain as well. Her story of his life, "Homage to Iowa: The Inside Story of Ignacio V. Ponseti," was published in 2007. Dr. Ponseti also is survived by his son, Bill Ponseti. Arrangements for a celebration of life are pending.
Note to Editors: This news release includes information and text taken from the following print sources: "Dr. Ignacio V. Ponseti and the Spanish Civil War: An Oral History of the University of Iowa Distinguished Professor of Orthopedics" by Charles E. Hawtrey, M. D., Professor Emeritus, Urology, University of Iowa; "A Healing Touch" by Carol Wilcox, Iowa Alumni Magazine Feb. 2003; a story by Timothy Bascom in the Spring 2000 Iowa's College of Medicine newsletter; and a story by Timothy Bascom for Iowa Alumni Magazine.
For more information:
"Be Remarkable" Profile of Ponseti:
How the Internet helped advance the Ponseti method:
An oral history of the Spanish Civil War by Ponseti:
An October 2008 article in BioMechanics describing scientific evidence supporting the use of the Ponseti method:
Ponseti International Association:
Iowa Hospital Association:
In addition, tributes are being posted at two Facebook pages - at The Dr. Ignacio Ponseti Appreciation Society and at the Ponseti International Association Club:
STORY SOURCE: University of Iowa Health Care Media Relations, 200 Hawkins Drive, Room E110 GH, Iowa City, Iowa 52242-1009
MEDIA CONTACT: Tom Moore, 319-356-3945, firstname.lastname@example.org; Compiler: Becky Soglin.