New Standard of Care for Clubfoot

Sept. 27, 2005 — -- Holly and Patrick Wasilewski were devastated at Holly's 18-week pregnancy check-up -- they found out their son would be born with a clubbed right foot.

Clubfoot is one of the most common birth defects, occurring in one out of every 1,000 U.S. births. With a clubbed foot, a normal infant is born with a stiff, in-turned foot that cannot be returned to a normal position. About 50 percent of clubfoot newborns have both feet affected. If not treated, clubfoot does not self-correct, causing the person to walk abnormally for life.

The Wasilewskis' doctor reassured them that clubfoot was an easily treatable abnormality. Yet Holly found it unsettling that in their home state of Michigan, 95 percent of clubfoot newborns underwent surgery for treatment.

Holly, 33, started to research on her own. She came across a support group on the Internet for parents of children with clubfoot. The other parents warned her away from surgery, saying, "You have to go to Dr. Ignacio Ponseti."

In the late 1940s, Ignacio Ponseti of the University of Iowa noticed that many of his patients whose clubbed foot had been treated surgically faced problems later in life. He decided there must be a better way to treat the deformity.

For years, surgery was the standard practice, Ponseti explained, because "it gives quick, visual results." However, patients often reported severe foot pain years later due to stiff scar tissue and twisted joints.

Clubbed feet occur when a fetus develops with its feet twisted in toward one another. Ponseti reasoned that he should be able to twist the feet back out into their normal position.

Previous methods had followed this same line of reasoning, but with little success. The trouble was that as a clubbed foot grows it is following a bent blueprint. Ponseti carefully studied newborns' foot joints, using stillborn babies in order to understand how best to reform the feet. The technique he came up with corrected an infant's clubbed foot continuously as it grew.