Walk This Way 2009
The paediatric foot clinic at Barts Health has adopted an innovative and highly successful US method for treating clubfoot. Around 1 in 1,000 newborns suffer from clubfoot, with their feet curved inwards. Without treatment, they will be forced to walk on the sides of their feet – causing great pain and badly damaging their feet. Conventional surgical corrections are rarely wholly successful and the condition often recurs. Using a pioneering new technique developed in the USA, consultant orthopaedics and trauma surgeon Mr Manoj Ramachandran, senior physiotherapist Di Coggings and their colleagues are dramatically improving clubfoot treatment.
In the 1950s, a US surgeon, Dr Ignacio Ponseti, carefully analysed the anatomical abnormalities of clubfoot and came up with an alternative treatment minimising the amount of corrective surgery required. The ‘Ponseti technique’ gradually remoulds infants’ feet. Babies’ feet are gently but firmly massaged then encased in plaster casts. Following this course of treatment, some minor surgery may be required, performed in the clinic setting. Once their feet have been straightened, infants wear specially designed shoes joined by a bar for up to four years. The treatment is undeniably intensive, but by about age 6 children’s feet are often entirely normal, and the cure seems to be permanent.
Dr Ponseti developed the method in the 1950s yet it received relatively little attention until promoted by enthusiastic advocates. It is now widely recognised as the best treatment for clubfoot. It is, however, technically challenging: it calls for great skill, and each case is unique.
Manoj Ramachandran and Di Coggings were early converts to the Ponseti technique. Remarkably, Dr Ponseti was still practising in his 90s and, with funding from Barts and The London Charity, Mr Ramachandran and colleagues were able to travel to Iowa to learn from the field’s pioneering figure first hand. Sadly, Dr Ponseti died just weeks after the visit.
The trip provided an invaluable opportunity to gain from the experience of 50 years of treatment, and to cement links with Dr Jose Morcuende, who continues Dr Ponseti’s work in Iowa. Mr Ramachandran and colleagues have continued to develop novel techniques, for example using a modified Ponseti technique to treat a less common foot condition.
The Barts and The London Children's Hospital paediatric foot clinic is now the UK’s largest centre, with satellite clinics established in other hospitals in East London, Essex and beyond. Mr Ramachandran and colleagues are passing on their training – and Dr Ponseti’s wisdom – to other paediatric orthopaedic surgeons, so even more infants can benefit from this life-changing treatment.
The paediatric foot clinic at Barts Health has adopted an innovative and highly successful US method for treating clubfoot. Around 1 in 1,000 newborns suffer from clubfoot, with their feet curved inwards. Without treatment, they will be forced to walk on the sides of their feet – causing great pain and badly damaging their feet. Conventional surgical corrections are rarely wholly successful and the condition often recurs. Using a pioneering new technique developed in the USA, consultant orthopaedics and trauma surgeon Mr Manoj Ramachandran, senior physiotherapist Di Coggings and their colleagues are dramatically improving clubfoot treatment.
In the 1950s, a US surgeon, Dr Ignacio Ponseti, carefully analysed the anatomical abnormalities of clubfoot and came up with an alternative treatment minimising the amount of corrective surgery required. The ‘Ponseti technique’ gradually remoulds infants’ feet. Babies’ feet are gently but firmly massaged then encased in plaster casts. Following this course of treatment, some minor surgery may be required, performed in the clinic setting. Once their feet have been straightened, infants wear specially designed shoes joined by a bar for up to four years. The treatment is undeniably intensive, but by about age 6 children’s feet are often entirely normal, and the cure seems to be permanent.
Dr Ponseti developed the method in the 1950s yet it received relatively little attention until promoted by enthusiastic advocates. It is now widely recognised as the best treatment for clubfoot. It is, however, technically challenging: it calls for great skill, and each case is unique.
Manoj Ramachandran and Di Coggings were early converts to the Ponseti technique. Remarkably, Dr Ponseti was still practising in his 90s and, with funding from Barts and The London Charity, Mr Ramachandran and colleagues were able to travel to Iowa to learn from the field’s pioneering figure first hand. Sadly, Dr Ponseti died just weeks after the visit.
The trip provided an invaluable opportunity to gain from the experience of 50 years of treatment, and to cement links with Dr Jose Morcuende, who continues Dr Ponseti’s work in Iowa. Mr Ramachandran and colleagues have continued to develop novel techniques, for example using a modified Ponseti technique to treat a less common foot condition.
The Barts and The London Children's Hospital paediatric foot clinic is now the UK’s largest centre, with satellite clinics established in other hospitals in East London, Essex and beyond. Mr Ramachandran and colleagues are passing on their training – and Dr Ponseti’s wisdom – to other paediatric orthopaedic surgeons, so even more infants can benefit from this life-changing treatment.