LIFE

New book tells amazing story of Ponseti and his miraculous method

Dick Hakes
Taking Liberties

The 12th floor of the new University of Iowa Stead Family Children’s Hospital was a fitting place to meet with two Iowa City men who are key players in the worldwide quest to help kids with clubfoot walk.

One is Tom Cook, a retired University of Iowa professor whose new book on the acclaimed Ponseti Method was just released Friday.

The other is Dr. Jose Morcuende, a pediatric orthopedic surgeon at the university who trains doctors here and abroad on how to use the techniques first pioneered by his predecessor, Dr. Ignacio Ponseti, some 75 years ago.

In a conference room ringed by huge glass windows offering a spectacular view of Kinnick Stadium, these two dedicated men tell stories they call good medicine but which sound more like miracles.

Before a word is said, Dr. Morcuende calls up a recent video on his phone, sent to him from an associate in Colombia which shows a 15-year-old girl struggling in vain to walk with a severely deformed left foot and ankle – a classic clubfoot patient.

Tom Cook took this photo of a nurse holding a baby following application of plaster casts to correct clubfoot in Gboko, Nigeria a few years ago. About half of the children born with clubfoot have the disability in both feet, as does this child.

He then shows me a second video of the same girl taken just two months later. 

Her foot looks normal and she is walking steadily toward the camera, her formerly unusable appendage made useable. The image speaks volumes.

This is just one of a multitude of videotaped examples of the amazing success of the Ponseti Method, sometimes referred to as “Iowa’s Gift to the World.”

Cook’s new book titled “Clubfoot: The Quest for a Better Life for Millions of Children,” expertly chronicles the late Dr. Ponseti’s life, his success and his continuing legacy in very readable form. It’s available directly through Ice Cube Press in North Liberty or most bookstores.

“I felt the whole story needed to be told,” said the author, stating the book took him four years to write. “I did not want it to get lost in time.”

Respected journalist and clubfoot elimination advocate Tom Brokaw’s quote is featured on the cover. He touts the book as highlighting the “truly remarkable life story of Dr. Ponseti and his continuing impact on the lives of children around the world.”

Both the author and Dr. Morcuende worked closely with Ponseti, who died in 2009 at age 95. Their respect for their colleague is clear.

“He actually saw patients on the day he died,” said Cook, a professor emeritus in the College of Public Health. He now heads global operations for the non-profit Ponseti International Association after a 38-year teaching career at the University. Visit its website at www.ponseti.info/

Dr. Ponseti was still active in medicine and the application of his clubfoot correction technique well into his 90s. Here he is photographed with a young patient about two years before his death in 2009.

His new book tells the story of the son of a struggling watchmaker in the ancient small town of Ciutadella, Spain, who eventually settled and made medical history in Iowa.

“My wife and I visited his birthplace in Spain,” said Cook. “There’s a plaque on the wall of the watch shop where the family lived upstairs. The city recognized his great contribution and gave Ponseti the key to the city in 1984.”

Ponseti earned a degree in medicine from Barcelona University, fled Spain during the civil war there and then settled in Iowa City in 1941 to study orthopedics under Dr. Arthur Steindler at the University of Iowa. He immediately decided there was a better way to treat clubfoot than through surgery and developed his renowned method only a few years later.

He discovered a clubfoot can be slowly and effectively realigned by applying a series of plaster casts changed weekly four to six times and then clipping the Achilles tendon under a local anesthetic. A special brace is then worn at night for the next four years to allow the foot to grow normally.

“I tell people it’s like orthodontics,” said Cook. “You slowly add a little tension and let nature do the remodeling.”

Dr. Morcuende points out that although the basics of the procedure are simple and have been in place for decades, meticulous training is required for doctors to get successful results. More than 100 physicians from other countries have come to the University over the years to spend two weeks with him, learning how to evaluate patients and apply the casts properly, not to mention countless other physicians from the United States.

“This method has to be followed properly or it doesn’t work,” said Dr. Morcuende. Doctors sometimes pass the procedure on to lesser-trained subordinates, which is a problem, he said. If applied properly, the method has more than a 95 percent success rate. 

He has also made an estimated 200 trips to foreign countries such as Pakistan and Nigeria to set up clinics and check in with his trainees. About two dozen orthopedists come to Iowa City for training on the method every year.

Cook says Ponseti spent much of his career struggling to convince surgeons that his method was more successful, less expensive and easier on patients than orthopedic surgery. He claims that the Internet changed that in the 1990s when mothers across the globe learned of the Ponseti Method’s success. Today, he says, it is considered “the gold standard” for clubfoot treatment throughout the medical community.

Author Tom Cook (left), professor emeritus at the University of Iowa, shows a copy of his just-released book on Dr. Ignacio Ponseti to friend and colleague Dr. Jose Morcuende, who trains doctors worldwide in the Ponseti Method for correcting clubfoot.

“Parents around the world got their doctors to pay attention,” he said.

Clubfoot remains the world’s most common skeletal birth defect, affecting one in 750 children. It is present in some 200,000 newborns every year and occurs in every country around the globe, including the U.S.

In developing countries, clubfoot children can suffer from more than just the physical disability. They are often shunned, abused, must beg on the street or if lucky, end up in orphanages. 

Both men agreed videos of children walking after years of misery are the best tribute to Ponseti, whom Cook described as “soft-spoken, gentle, humble, incredibly smart and determined to get the best care for his patients.”

What drives these two advocates to push so hard to get doctors fully-trained to use this technique successfully?

“It is simply a life-changing treatment,” Dr. Morcuende said, “and I want kids born with clubfoot anywhere in the world to have access to a doctor who can perform it.”

Cook says his motivation to work for the Ponseti non-profit comes from imagining himself as a grandparent on the other side of the world with a clubfoot grandchild.

“If I found out there was a simple method – low-cost, low-tech, a do-anywhere remedy,” he said, “wouldn’t I want somebody to step up and help?” 

It’s pretty much a given that Cook and Dr. Morcuende will continue to do just that.