Ignacio Ponseti (3 June 1914 – 18 October 2009), also known as Ignasi Ponsetí i Vives , was a Spanish-American physician, specializing in orthopedics . He was born on 3 June 1914 in Menorca , part of the Balearic Islands , Spain , Ponseti was the son of a watchmaker and spent his childhood helping repair watches. This skill was said to eventually contribute to his abilities as an orthopedist. He served three years as a medic during the Spanish Civil War treating orthopedic injuries of wounded soldiers. He left Spain shortly after the end of the war and became a faculty member and practicing physician at the University of Iowa , where he developed his ground-breaking, non-surgical treatment for the clubfoot defect - the Ponseti Method.
50-529: In the 1950s, Ignacio Ponseti developed the Ponseti method (also known as the Ponseti technique), a non-surgical technique that uses a series of casts, followed by an abduction brace, to correct congenital clubfoot . The condition causes a baby's feet to turn inward and downward; if not corrected, the child will be unable to walk or move properly. He was known for this method of clubfoot treatment that bears his name, and
100-456: A bean-shaped foot. At the end of the first step, the foot is maximally abducted but never pronated. The manipulation is carried out in the cast room, with the baby having been fed just prior to the treatment or even during the treatment. After the foot is manipulated, a long leg cast is applied to hold the correction. Initially, the short leg component is applied. The cast should be snug with minimal but adequate padding. The authors paint or spray
150-511: A career in orthopaedics. Without ambulances, Ponseti used the help of local smugglers to take the injured into France. He soon escaped to France himself and went to Mexico, where for two years he practiced family medicine. A physician there helped him get to Iowa in 1941 to study orthopaedics under Arthur Steindler, M.D. Ponseti completed a residency at Iowa in 1944 and became a member of the orthopaedic faculty at University of Iowa Hospitals and Clinics . Early in his career at Iowa, Ponseti saw that
200-497: A clinician manipulates softened foot ligaments to gradually achieve near-normal muscle and bone alignment. In addition to the improved physical outcomes, compared to surgery, the Ponseti method is less expensive and can be taught to nonphysician health care providers, which is useful in areas with few or no doctors. Clubfoot is the most common musculoskeletal birth deformity, affecting 200,000 newborn children each year worldwide, 80% of whom are in developing countries. The Ponseti method
250-636: A partnership with the Tim Tebow Foundation , CURE Philippines performs over 1,200 reconstructive plastic and orthopedic surgeries every year for children suffering from treatable disabilities. Located in Davao City , the hospital has 30 beds and three operating rooms to treat pediatric patients with conditions like clubfoot, cleft lip and palate as well as disabilities following chronic burn contractures. CURE Philippines also provides emotional and spiritual support to patients and their communities. CURE and
300-476: A program to treat infant clubfoot called CURE Clubfoot Worldwide in 2006. This program then began to expand beyond CURE hospitals and partnered with other national hospitals and established clinics in countries that CURE International did not have a presence in, like Rwanda , Mozambique and India . In 2019, CURE Clubfoot spun off from CURE as a new independent NGO , and was renamed Hope Walks . CURE Children's Hospital of Uganda attracts surgeons from around
350-653: A regional learning institution. In 2006, CURE acquired Oasis Hospital in Al Ain , United Arab Emirates. The hospital was established in 1960 by the American missionary couple Pat and Marian Kennedy, who were a part of the missionary organization TEAM (the Evangelical Alliance Mission). The hospital has a focus on maternal health and is the oldest hospital in Al Ain. The hospital became the first non-government hospital in
400-496: A related website devoted to parents' interests and needs. Groups that work with Ponseti International include CURE International and A Leg to Stand On (India) and Pehla Qadam (Pakistan). World Clubfoot Day was introduced in 2013 by Ponseti International Association, and is celebrated on June 3 every year, commemorating Ponseti's birthday. This date was chosen following the signing of the Iowa Clubfoot Declaration during
450-544: A tibialis anterior tendon transfer to the lateral cuneiform is performed when the child is approximately three years of age. This gives lasting correction of the forefoot, preventing metatarsus adductus and foot inversion. This procedure is indicated in a child aged 2–2.5 years with dynamic supination of the foot. Prior to surgery, cast the foot in a long leg cast for a few weeks to regain the correction. CURE International CURE International , based in Grand Rapids, MI ,
500-475: Is a Christian nonprofit organization that owns and operates eight charitable children's hospitals around the world. CURE provides medical care to pediatric patients with orthopedic , reconstructive plastic , and neurological conditions. The organization's stated mission is to "heal the sick and proclaim the kingdom of God." The organization currently operates hospitals in Ethiopia , Kenya , Malawi , Niger ,
550-424: Is anesthetized with a combination of a topical lignocaine preparation (e.g. EMLA cream) and minimal local infiltration of lidocaine. The tenotomy is performed through a stab incision with a round tip (#6400) Beaver blade. The wound is closed with a single absorbable suture or with adhesive strips. The final cast is applied with the foot in maximum dorsiflexion, and the foot is held in the cast for 2–3 weeks. Following
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#1732898948450600-428: Is based on the inherent properties of the connective tissue, cartilage, and bone, which respond to the proper mechanical stimuli created by the gradual reduction of the deformity. The ligaments, joint capsules, and tendons are stretched under gentle manipulations. A plaster cast is applied after each manipulation to retain the degree of correction and soften the ligaments. The displaced bones are thus gradually brought into
650-471: Is endorsed and supported by the World Health Organization, National Institutes of Health, American Academy of Orthopedic Surgeons, Pediatric Orthopedic Society of North America, European Pediatric Orthopedic Society, CURE International , STEPS Charity Worldwide, STEPS Charity South Africa, and A Leg to Stand On (India). The calcaneal internal rotation (adduction) and plantar flexion
700-733: Is one of Africa's leading pediatric hospitals for brain surgery and the treatment of neurological conditions. It provides minimally-invasive endoscopic neurosurgical procedures and attracts surgeons from around the world to its CURE Neuro Fellowship Program. The teaching hospital consists of three operating rooms, an 18-bed intensive care unit and 37 ward beds. Hospital staff complete approximately 1,500 surgical procedures annually for children with conditions including hydrocephalus, spina bifida, brain tumors, and other neural tube defects. CURE Uganda also provides emotional and spiritual support to patients and their communities. On August 2, 2011, three representatives of CURE Hydrocephalus testified in front of
750-401: Is the first and only hospital in the country of 14 million people to provide orthopedic care for disabilities such as clubfoot, bowed legs, and knock knees to children regardless of their economic status. The teaching hospital was expanded in 2023 to include 42 beds, three operating theaters, an outpatient clinic, and additional lodging for rehabilitation patients. The hospital was refurbished by
800-410: Is the key deformity. The foot is adducted and plantar-flexed at the subtalar joint, and the goal is to abduct the foot and dorsiflex it. In order to achieve correction of the clubfoot, the calcaneus should be allowed to rotate freely under the talus bone , which also is free to rotate in the ankle mortise. The correction takes place through the normal arc of the subtalar joint. This is achieved by placing
850-645: Is the only hospital in the country of over 24 million that offers specialty surgical care for children living with treatable physical disabilities. Its location was chosen because it is central to one of the most underdeveloped regions in the world. Strategically located in Niamey, CURE Niger is a children's hospital offering 25 beds, two operating rooms, and a full range of high-demand ancillary and rehabilitation services to over 500 surgical patients each year. CURE Niger also provides emotional and spiritual support to patients and their communities . Established in 2014 through
900-527: Is used, for example, in Uganda, where efforts continue to improve the availability of the treatment. The Ponseti method is effective when properly applied by a trained health care provider and is considered the "gold standard" treatment, leading to a normal, productive life. Nearly 80% of children can expect an excellent to good long-term outcome; however, a minority of children will get recurrence requiring repeated treatment, or on occasion surgery. Non-compliance with
950-607: The 2010 Haiti earthquake by sending in one of the first surgical teams into that country. The hospital ceased doing surgical operations in 2018. Honduras : In 2013, the CURE Internacional Hospital de Ortopedia Pediátrica, located in San Pedro Sula , closed due to increasing insecurity in the country, and a lack of funding from the government. During its four years of operation, approximately 20,000 children were treated with orthopedic corrections. CURE established
1000-466: The Philippines , Uganda , Zambia and Zimbabwe . CURE treats conditions like clubfoot , knock knees , bowed legs , cleft lip / palate , burn contractures , hydrocephalus , and encephalocele . Established in 2008, CURE Ethiopia performs over 2,500 reconstructive and orthopedic surgeries every year for children suffering from treatable disabilities. Located in the capital city of Addis Ababa ,
1050-807: The U.S. House of Representatives Subcommittee on Global Health, Global Human Rights and International Organizations . Dr. Benjamin Warf , former medical director of CURE Uganda, Dr. Steven Schiff, who conducted research at CURE Uganda, and Jim Cohick, Senior Vice President of Specialty Programs at CURE International, spoke on the issue. On August 1, 2022, BBC World Service Television reported on an innovative surgical procedure available at CURE Uganda for pediatric patients with hydrocephalus . Established in 2006, CURE Zambia performs over 1,600 reconstructive, orthopedic, ENT, and audiological surgeries each year for children suffering from treatable disabilities. Located in Lusaka ,
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#17328989484501100-496: The 2nd International Clubfoot Symposium held in Iowa City, Iowa, USA, on October 4 – 5, 2012. The goal of World Clubfoot Day is to raise awareness about clubfoot disability and its prevention using the Ponseti method. Information about the use of the Ponseti method can be found at these sites: Ponseti method The Ponseti method is a manipulative technique that corrects congenital clubfoot without invasive surgery. It
1150-674: The Tebow Foundation announced plans to build a children's hospital in the fall of 2011 in the Philippines , the country where ESPN broadcaster Tim Tebow was born. The Tebow CURE Hospital in Davao City , on the island of Mindanao , will hold 30 beds and will specialize in orthopedics . Construction began in January 2012 and was completed in late 2014, with a grand opening in May 2015. Officially opened in Mbale , Uganda on January 19, 2001, CURE Uganda
1200-477: The University of Iowa, Ponseti realized that surgical approaches did not fully correct clubfoot and/or created problems later in life, such as severe arthritis or even requiring more surgery. In working to develop a new approach, he determined it could be nonsurgical. The Ponseti method uses gentle, manual manipulation of the foot, followed by application of toe-to-groin plaster casts. The casts are changed weekly after
1250-665: The Zimbabwe Orthopedic Trust in partnership with the Zimbabwean government and is located adjacent to United Bulawayo Hospital (UBH) in Bulawayo . The organization was founded in 1996 in central Pennsylvania , near Harrisburg , by C. Scott Harrison and his wife, Sally. Ten years earlier, Harrison had traveled to Malawi, Africa to perform spine surgery and teach higher level orthopedic surgery skills to local surgeons. When his tenure as CEO and President of Kirschner Medical
1300-482: The city's and region's growing list. From Spectrum Health , St. Mary's, Metro Health , Cherry Health and so many more. I can proudly say we are home to CURE International." United Arab Emirates : The Kanad Hospital (formerly CURE Oasis Hospital ), located in Al Ain , was established in 1960 to bring American medical care to the UAE. The hospital delivers 3,500 babies and treats over 122,000 patients annually. CURE acquired
1350-470: The clubfoot. Poorly conducted manipulations will further complicate the clubfoot deformity. The non-operative treatment will succeed better if it is started a few days or weeks after birth and if the podiatrist understands the nature of the deformity and possesses manipulative skill and expertise in plaster-cast applications. The Ponseti technique is painless, fast, cost-effective and successful in almost 100% of all congenital clubfoot cases. The Ponseti method
1400-404: The correct alignment with their joint surfaces progressively remodeled yet maintaining congruency. After two months of manipulation and casting the foot appears slightly over-corrected. After a few weeks in splints, however, the foot looks normal. Proper foot manipulations require a thorough understanding of the anatomy and kinematics of the normal foot and of the deviations of the tarsal bones in
1450-592: The curvature patterns of idiopathic scoliosis , and demonstrated that curves progressed after skeletal maturity. He also conducted many studies evaluating the long-range results of treatments for congenital dislocation of the hip, clubfoot and scoliosis. Ponseti was succeeded at the University of Iowa by his longtime colleague Dr. Jose Morcuende, who has continued Ponseti's legacy of clubfoot patient treatment, research, and training physicians globally on this highly effective and non-invasive approach. Clubfoot affects well over 100,000 newborns annually. Early in his career at
1500-464: The division became a separate company, renamed CURE Management Services, or CMS, and continued to operate for a few years. The company is no longer active. CURE International relocated to Grand Rapids, Michigan , in September 2021. At a grand opening celebration, Grand Rapids Mayor Rosalynn Bliss noted, "(CURE's) work is nothing short of a miracle...We now have another strong medical provider to add to
1550-608: The emirate of Abu Dhabi to receive the Joint Commission International Accreditation in 2007 and was re-accredited in 2010 and 2013. CURE created a separate division for management of international hospitals, called CURE Healthcare Management Services, in the late 2000s. Capabilities ranged from initial strategic analysis of a project to construction, staffing, outfitting and management. Clients included hospitals not owned by CURE International, in countries such as China , Indonesia and Angola . In 2012
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1600-427: The equinus should be corrected without causing a midfoot break. It generally takes up to 4–7 casts to achieve maximum foot abduction. The casts are changed weekly. The foot abduction (correction) can be considered adequate when the thigh-foot axis is 60°. After maximal foot abduction is obtained, most cases require a percutaneous Achilles tenotomy. This is performed in the cast room under aseptic conditions. The local area
1650-405: The forefoot against counter pressure on the lateral aspect of the head of the talus. The knee is flexed to 90° for the long leg component of the cast. The parents can soak these casts for 30–45 minutes prior to removal with a plaster knife. The authors' preferred method is to use the oscillating plaster saw for cast removal. The cast is bivalved and removed. The cast then is reconstituted by coapting
1700-407: The forefoot is pronated. If cavus is present, the first step in the manipulation process is to supinate the forefoot by gently lifting the dropped first metatarsal to correct the cavus. Once the cavus is corrected, the forefoot can be abducted. Pronation of the foot also causes the calcaneus to jam under the talus. The calcaneum cannot rotate and stays in varu; the cavus then increases, resulting in
1750-576: The hospital in 2006. CURE International and True Sojourners entered into an agreement that transitioned the Kanad Hospital in Al Ain, United Arab Emirates, between the parties, effective October 1, 2020. Dominican Republic : The Centro de Ortopedia y Especialidades CURE International, established in 2003, was located in Santo Domingo . It served approximately 700 outpatients per month. The hospital also sent surgical teams into Haiti and responded to
1800-421: The index finger of the operator on the medial malleolus to stabilize the leg and levering on the thumb placed on the lateral aspect head of the talus while abducting the forefoot in supination. Forcible attempts at correcting the heel varus by abducting the forefoot while applying counter pressure at the calcaneocuboid joint prevents the calcaneus from abducting and therefore everting. Foot cavus increases when
1850-406: The limb with tincture of benzoin to allow adherence of the padding to the limb. The authors prefer to apply additional padding strips along the medial and lateral borders to facilitate safe removal of the cast with a cast saw. The cast must incorporate the toes right up to the tips but not squeeze the toes or obliterate the transverse arch. The cast is molded to contour around the heel while abducting
1900-464: The manipulation and casting phase, the feet are fitted with open-toed straight-laced shoes attached to a Denis Browne bar . The affected foot is abducted (externally rotated) to 70° with the unaffected foot set at 45° of abduction. The shoes also have a heel counter bumper to prevent the heel from slipping out of the shoe. The shoes are worn for 23 hours a day for three months and are worn at night and during naps for up to three years. In 10–30% of cases,
1950-555: The method is the greatest risk-factor for failure. At the 2007, International Clubfoot Symposium attended by 200 doctors from 44 countries, papers were presented regarding an estimated 10,000 children successfully treated with the technique around the world in recent years. The Ponseti International Association for the Advancement of Clubfoot Treatment was founded in 2006 to improve the treatment of children born with clubfoot, through education, research and improved access to care. PIA has
2000-572: The outcomes of clubfoot surgical treatments were not very good - patients had limited movement. He set out to develop a treatment that made the most of babies' flexible ligaments. The method was met with some opposition but over the past 50 years it has been adopted by the majority of doctors and other health care providers worldwide, being considered the gold standard for treatment, including in Britain and Turkey. Well into his nineties, Ponseti continued to see patients and trained visiting doctors from around
2050-644: The residency and fellowship levels. CURE Kenya also provides emotional and spiritual support for patients and their communities. The African Inland Church (AIC) provided the initial land for the hospital premise as a gift to the people of Kenya. Established in 2002, Beit-CURE International in Malawi is the only hospital in Sub-Saharan Africa recognized by the Royal College of Surgeons of England . Located in Blantyre,
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2100-437: The teaching hospital comprises 58 beds, three operating theaters, and performs over 1,200 reconstructive and orthopedic surgeries each year for people suffering from treatable disabilities. CURE Malawi also provides emotional and spiritual support to patients and their communities. The Beit Trust, a UK-based charity, provided the initial funding for this facility as a gift to the people of Malawi. Established in 2010, CURE Niger
2150-524: The teaching hospital comprises six buildings, 54 beds, and three operating theaters. CURE Zambia also provides emotional and spiritual support to patients and their communities. The Beit Trust, a UK-based charity, provided the funding for this facility as a centennial gift to the people of Zambia. CURE Zambia is a strategic partner with the Zambian Ministry of Health. Established in April 2021, CURE Zimbabwe
2200-418: The teaching hospital has 70 beds and four operating rooms. CURE International partners with The College of Surgeons of East, Central, and Southern Africa (COSECSA) to serve as a regional learning institution by implementing an orthopedic pediatric training program at the residency and fellowship levels. CURE Ethiopia also provides emotional and spiritual support to patients and their communities. CURE Kenya
2250-423: The two halves. This allows for monitoring of the progress of the forefoot abduction and, in the later stages, the amount of dorsiflexion or equinus correction. Forcible correction of the equinus (and cavus) by dorsiflexion against a tight Achilles tendon results in a spurious correction through a break in the midfoot, resulting in a rocker-bottom foot. The cavus should be separately treated as outlined in step 2, and
2300-426: The world. He also developed new prosthetic devices with John Mitchell of MD Orthopaedics, Inc. and produced training and information DVDs on the method. Ponseti's other research focused on congenital and developmental bone and joint disorders, skeletal growth disorders in children, and the biochemistry of cartilage. He gained insight in the early 1950s on the effect of amino nitriles on collagen cross linking, defined
2350-526: Was Africa's first orthopedic teaching hospital when it opened in Kijabe in 1998. Each year it performs over 1,500 reconstructive and orthopedic surgeries for children suffering from treatable disabilities. The teaching hospital has 47 beds and four operating rooms. CURE International partners with The College of Surgeons of East, Central, and Southern Africa (COSECSA) to serve as a regional learning institution by implementing an orthopedic pediatric training program at
2400-802: Was Professor Emeritus in the Department of Orthopaedic Surgery at University of Iowa Hospitals and Clinics. Ponseti studied medicine at Barcelona University. Not long after he graduated, fighting broke out between the Nationalists and the Republicans - the start of the Spanish Civil War. Ponseti served as a medical officer with the Loyalists as a lieutenant, then captain, in the Orthopaedic and Fracture Service. His duties included setting fractures, which put him on
2450-641: Was developed by Ignacio V. Ponseti of the University of Iowa Hospitals and Clinics , US, in the 1950s, and was repopularized in 2000 by John Herzenberg in the US and Europe and in Africa by NHS surgeon Steve Mannion. It is a standard treatment for clubfoot. Ponseti treatment was introduced in UK in the late 1990s and widely popularized around the country by NHS physiotherapist Steve Wildon. The manipulative treatment of club foot deformity
2500-719: Was over, Harrison created the Crippled Children's United Rehabilitation Effort (CCURE or C²URE, later CURE), hoping to meet that need. Harrison stepped down as President in 2012. In partnership with the Africa Inland Church, CURE opened its first hospital in 1998 in Kijabe, Kenya . The African Inland Church (AIC) provided the initial land for the hospital premise as a gift to the people of Kenya. The AIC-CURE Children's Hospital of Kenya partners with The College of Surgeons of East, Central, and Southern Africa (COSECSA) to serve as
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