Ignacio Ponseti –

the gentle revolution of clubfoot treatment

Von Carles garcia-roca - Eigenes Werk, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=3050126


With the Ponseti Method named after him, the physician Ignacio Ponseti revolutionized clubfoot treatment. Who was the man - and what was his groundbreaking insight? An overview.



Ignacio Ponseti was born in Ciutadella (Menorca, Spain) on June 3, 1914. Shortly after completing his medical studies in Barcelona, the Spanish Civil War broke out. Initially, Ponseti fought on the side of the Loyalists against the coup-mongering General Francesco Franco - but later fled to Mexico via France, where he practiced medicine. In 1941, he began studying orthopedics in Iowa (USA), and in 1944 he received an unrestricted residency permit and became a member of the orthopedic faculty at the University of Iowa Hospitals and Clinics. While practicing medicine, he developed the Ponseti Method, which fundamentally revolutionized clubfoot treatment. He died Oct. 18, 2009, at the age of 95. Details of his life can be found in an extensive English-language Wikipedia article and in the biography of his wife, Helena Percas-Ponseti (Homage to Iowa: The Inside Story of Ignacio V. Ponseti. University of Iowa Press, 2007).



Methods of clubfoot treatment - from archaic to surgical

Ponseti's greatest medical achievement is a finding that is as simple as it is groundbreaking. He recognized, that the various bones, cartilage and ligaments in the foot are connected as a functional unit. This knowledge - known as kinematic coupling - has fundamentally changed clubfoot treatment. Until then, there have been two roughly simplified methods for treating clubfoot. The "mechanical method" was already practiced in the Middle Ages. Here, the foot was forced into the desired position by means of sometimes adventurous screwing and pressing devices. If at all, the complex malposition could thus be visually corrected in a very painful way. A good and painless functionality was not achieved, so that these methods could not establish themselves. We owe the second approach, surgical intervention, to modern medicine. It became established in Germany in the 1980s. In simplified terms, the foot is opened and the affected bones and ligaments are rearranged. In this way, clubfoot can be corrected both visually and functionally. However, long-term studies show that affected individuals often complain of pain and may experience increased problems with recurrence or stiffness. In addition, the operation is a stressful procedure for patients. 


Everything is connected - the kinematic coupling

With the realization of kinematic coupling, Ponseti found the answer to the question of why purely mechanical correction had not worked in practice until now. In "disordered" mechanical displacement, the shortened tendons, which are connected to the bones in a complex network, prevent the functionally correct arrangement in the foot. Ponseti recognized how the various components are connected (kinematic coupling) - and how this knowledge can be used to treat clubfoot. In the Ponseti Method, certain deformities that make up clubfoot, are treated sequentially instead of simultaneously with a multi-stage plaster rehabilitation. In the first stage of treatment, all deformities except the pointed foot component are corrected simultaneously. In this process, it is critical to keep the talus bone in its original position during manipulation with the thumb due to kinematic coupling. The foot is then fixed in the new position with a cast, allowing the tendons to stretch and the foot limbs to become accustomed to the new position. This step is repeated until the deformities are fully corrected. Subsequently, the pointed foot component is treated according to the same principle. Plaster treatment usually requires six to eight one-week casts each and is usually completed with an Achilles tendon tenotomy. Cutting the tendon with a small incision through the skin reduces traction and stress on the newly corrected foot. The tendon quickly grows back together in infancy. Subsequently, a brace treatment is required for several years, during which the foot is held in its new position by a night positioning brace (clubfoot bar) during sleeping hours. Studies show that brace treatment is an important component for lasting success, otherwise there is a risk of recurrence (relapse). Details of the treatment regimen can be found here.


Ponseti - a standard, but by no means everywhere

Starting in America, the Ponseti Method has established itself as a medical standard. But it took a long time for the Ponseti method to gain widespread acceptance in Germany and Europe. Across Germany, about 500 babies are currently born with clubfoot each year, and 540 cases are predicted for 2021. The majority can be successfully treated with the Ponseti method. However, the situation is very different in many countries in Africa or Eastern Europe - for example, due to a poor healthcare system with a lack of medical capacities or skills. That is why we are specifically committed to spreading the Ponseti method worldwide, among other things by supporting Ponseti workshops with training materials for doctors.


The Ponseti-Principle

further information about conservative clubfoot treatment

Scientific article - the current status in clubfoot therapy (german)

The scientific article describes in detail the anatomical deformity as well as the mode of action and the procedure of the clubfoot therapy according to Ponseti. Here you can download the document.

Ponseti treatment manual - international brochure

The 32-page manual was developed in collaboration with Ignacio Ponseti and is available in many different languages. The brochure serves the international dissemination of the method and shows in detail anatomical basics, the principle of the Ponseti treatment, as well as the process itself. Here you find the brochure in different languages for download.

The original by Ponseti – “Congenital Clubfoot – Fundamentals of Treatment”

Currently, the printed edition is mostly out of stock: With his book on the treatment methodology of congenital clubfoot, Ponseti lays the scientific foundation for a new, gentle form of therapy. Here the book is available for download as a free PDF document in several languages.


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