Alpha Omega Alpha Honor Medical Society

2011 Research Abstract

Dissemination of the Ponseti Method of Treatment for Clubfoot within the Brazil National Training Initiative

Investigator: Mark Fox, University of Iowa Roy J. and Lucille A. Carver College of Medicine
Mentor: Jose A. Morcuende, MD, PhD, University of Iowa, Division of Pediatric Orthopaedics and Musculoskeletal Oncology

Background: Clubfoot is a severely debilitating deformity causing the foot to be rotated inwards and downwards, resulting in loss of mobility. In Brazil—where the prevalence of clubfoot is estimated to be 1/1000 births—affected individuals face diminished prospects for education, employment, and general involvement in society. Previously, the preferred clubfoot treatment involved extensive surgeries that were prohibitively expensive in developing countries, resulting in thousands of neglected cases each year. The Ponseti method recently emerged as the gold standard of treatment for clubfoot. Involving a series of manipulations and castings, it is a minimally invasive, cost-effective treatment that is ideal for use in developing nations. Recently, international physicians collaborated with Brazilian orthopaedists to conduct the first nationwide program in Latin America directed at teaching the Ponseti method. The aim of this study was to evaluate the geographical reach of the educational initiative as well as assess its impact on clubfoot treatment in Brazil.

Methods: From 2007 to 2008, 21 seminars were offered, reaching 556 orthopaedists from every state in Brazil. These expert-led, two day programs consisted of lectures, supervised cast applications and clinical discussions. Five years later, a retrospective study was performed to evaluate the clinical success of the initiative and its use as a model for other countries. Data was analyzed from 18 participating physicians, totaling approximately 1000 patients with 1600 affected feet.

Results: Participating physicians treated an average of 80 feet with the Ponseti method. They achieved an initial deformity correction rate of 96%, comparable to recent studies conducted worldwide. The high number of successfully treated patients illustrates a strong adaptation of the technique throughout Brazil.

Conclusion: The speed of dissemination and the exceptional rate of clubfoot correction achieved with the Brazil national Ponseti project underscore its success and viability as a model for other Latin American countries. The 58th world health assembly calls members to "facilitate access to appropriate assistive technology and to promote its development and other means that encourage the inclusion of persons with disability in society." The Ponseti method was shown to be a low cost treatment facilitating greater social integration for thousands of disabled persons in Brazil.

Updated on January 18, 2012.


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