Perfected nonsurgical method for curing clubfoot in infants

Ignacio Ponseti, 95, an Iowa doctor who perfected a nonsurgical technique 60 years ago for curing clubfoot in infants and saw it become widely adopted in the past dozen years, died Oct. 18 of complications from a stroke at University of Iowa Hospitals and Clinics in Iowa City.

Dr. Ponseti began working on the problem of clubfoot in the 1940s. Nearly 200,000 children each year are born with the defect, in which a foot is turned downward or sideways because of a tight, shortened Achilles' tendon. It is difficult and sometimes impossible to walk with clubfoot. Surgery, which was the standard treatment, often left children with "frozen" joints that led to later complications.

From his knowledge of the foot bones of infants, which are all cartilage, Dr. Ponseti believed that he could gently stretch the ligaments, joints and tendons into proper alignment. He then put the child in two thin plaster casts that reached from groin to toe. Over several weeks, the foot forms its proper shape, and by the time the child is 4 years old, he or she is through with cast, splint and nighttime braces. Although the technique requires careful training, it is considerably less complicated and less expensive than surgery.

"Physicians have been doing manipulation for clubfoot since Hippocrates, but they did not know how the joints moved. They just tried to smash the bones into position," Dr. Ponseti told a University of Iowa publication two years ago. "You have to be able to feel every one of the bones with your hands. It's a little bit like playing the piano."

Numerous international peer-reviewed studies showed success rates as high as 98 percent, but surgeons ignored it and rarely offered it as an alternative to upset parents.

"Surgeons love their little knives," he told the Chicago Tribune in 2006. "This is a deformity that's nothing really, yet if you don't treat it well, it's a tragedy."

During the first 40 years after Dr. Ponseti developed it, he and a handful of other orthopedic specialists treated several thousand children. But the need was much greater, and in an effort to spread the word, Dr. Ponseti wrote "Congenital Clubfoot: Fundamentals of Treatment" (1996). The parent of a child with clubfoot started an Internet mailing list that promoted the technique, and other parents who searched the Internet for medical treatments for their babies also began spreading the word. In August 2006, the American Academy of Pediatrics endorsed the method, and it finally entered the medical mainstream. Tens of thousands of children worldwide have benefited from the technique.

Ignasi Ponsetí Vives was born June 3, 1914, on the Spanish island of Minorca. He learned the watchmaking trade from his father, and the deliberate handling of tiny gears was an excellent preparation for his later work.

He entered medical school in Barcelona in 1930, completing his degree in 1936, just before the start of the Spanish Civil War. He served as a medical officer with the Loyalist army, but when Gen. Francisco Franco's fascist army gained control in 1939, Dr. Ponseti fled his homeland, evacuating 40 wounded patients with him by mule over the Pyrenees.

Dr. Ponseti soon left France for Mexico, where Spanish citizens were granted citizenship. He practiced medicine there for two years until moving to the University of Iowa in 1941 to study orthopedics. He completed his residency in 1944 and joined the faculty of the University of Iowa Hospitals and Clinics, where he remained until 1984. Although the majority of his work was on clubfoot, he also researched scoliosis and hip dysplasia and established a connective tissue laboratory at the University of Iowa.

Survivors include his wife of 48 years, Helena Percas-Ponseti of Iowa City; a son, Bill Ponseti of Novato, Calif.; seven grandchildren; and six great-grandchildren.