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

Sunday, October 21, 2012: 8:21 AM
Melrose (Hilton Riverside)
Mark H. Fox1, Monica Paschoal Nogueira, M.D./, Ph.D.2, Kathleen Kennedy Miller, B.A., Medical, Student1 and Jose Morcuende, M.D., Ph.D.3, (1)Carver College of Medicine, University of Iowa, Iowa City, IA, (2)Public Health, University of São Paulo, Sao Paulo, Brazil, (3)Department of Orthopaedics & Rehabilitation, University of Iowa Hospital and Clinics, Iowa City

Purpose: 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 has 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 orthopaedists from every state in Brazil and totaling 556 orthopaedists.   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 were analyzed from 18 participating physicians, totaling approximately 1000 patients with idiopathic clubfoot totaling 1600 affected feet.

Results: Orthopaedic surgeons stated that they had treated a total of approximately 4905 patients the year prior to attending the Ponseti symposium, including treatment with extensive surgery. 17% did not know the Ponseti technique by the time of the symposium. 88% reported they were able to treat children with Ponseti technique after the symposium. 94% of those reported the symposium changed their way of considering options for clubfoot treatment. In the five years after the symposiums, participating physicians treated an average of 80 feet with the Ponseti method. They achieved an initial deformity correction rate of 97%, 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 idiopathic clubfoot correction achieved with the Brazil National Ponseti Project underscore its success and viability as a model for other Latin American countries. The Ponseti method was shown to be a low cost treatment facilitating greater social integration for thousands of disabled persons in Brazil. These data could serve as a catalyst for policy change desperately needed in Brazil to improve quality of life for its citizens. It could also help other Latin American countries interested in developing a plan to spread the use of Ponseti method in their own nations.