We’ve had a lot of response from readers and listeners to our story on NPR’s Morning Edition on Monday, The Clubfoot Correction: How Parents Pushed For Better Treatment. Readers wrote that they or their children had received casting and boots-and-bars treatment for clubfoot. Some happened many decades ago—some fairly recently. We thought some more explanation is in order.
Dr. Ignacio Ponseti treated his first patient using the Ponseti method in 1948. He published his results 1963, and some physicians began to use it. But the method didn’t gain much traction until 1995, when he published a follow-up study on long-term results. Then, parents of babies born with clubfoot began to connect with each other on the internet, and the treatment spread even more widely, as this study shows.
But casting and boots-and-bars aren’t exclusive to the Ponseti method. For decades, orthopedic surgeons were starting treatment with some sort of casting. The problem was, it often didn’t work. Many children ended up needing major surgery (sometimes several surgeries). The Ponseti method standardized the treatment in a way that was more effective than other techniques. It includes full-leg casts instead of short-leg casts, for example, and a particular way of manipulating the feet before the casts are applied.
It’s important to also note that individual cases vary, both in terms of the severity of the problem and the response to treatment. There are people who had a great result with non-Ponseti casting and boots-and-bars treatment, and people who a great result with surgery. Even with Ponseti, there is about a 15 percent relapse rate. Most relapses either require another round of casting or minor surgery to move a tendon, as opposed to the major surgeries in the past. And for some of the most extreme cases of clubfoot, surgery may be more appropriate than the Ponseti method in the first place.
In 2010, The British Medical Journal published a summary of how treatment for clubfoot has evolved over the decades.
Our story noted the higher cost of surgery versus the Ponseti method. One reader raised the cost question from another perspective: How low are the reimbursement rates for the less invasive option? Too low to give doctors an incentive to perform it? They are good questions that we don’t know the answer to and important ones to raise in a time of health system change.
We appreciate all the thoughtful responses to our story.