clubfoot treatment without borders

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Clubfoot Treatment without Borders

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While heated debate over the establishment of a Palestinian state was taking place at the United Nations, Palestinian physicians were attending a course at Rambam. Course participants, Palestinian and Israeli physicians, learned to perform the non-invasive Ponseti method for treating clubfoot, a congenital defect that affects one in a thousand babies worldwide.

By Roberta Neiger, ProText

Neglected clubfoot is one of the most frequent causes of physical disability worldwide. “The Ponseti method is uniquely suited for use in developing areas because it can be taught to therapists, orthopedic assistants, and other health care providers,” said Dr Mark Eidelman, director of the Pediatric Orthopedic Department at Rambam, who organized the course, the first on this technique ever held in Israel. “The treatment does not require surgery, is economical and easy on the infant, and when implemented correctly, will greatly improve patients’ quality of life.”

Israeli, Palestinian and US orthopedic doctors participate in a workshop at Rambam
RHCC

For years, Dr Eidelman has treated complicated orthopedic cases that arrive from Palestinian Authority areas. “When we speak of pediatric medicine and saving seriously deformed babies from a life of suffering, we put politics aside and concentrate on medicine,” he said.

Nine Palestinian doctors from Palestinian Authority hospitals and 35 Israeli doctors attended the two-day course on September 22-23, along with two Nigerian physicians. From the West Bank and east Jerusalem, the Palestinians were provided by Rambam with meals and sleeping accommodations in Haifa. During the workshop, the doctors learned to perform the procedure on dolls, and viewed live an actual procedure that was took place at Rambam.

Workshop participants practice the Ponseti technique on dolls
RHCC

“It is very important that our residents gain first-hand acquaintance with this method and equally critical that the Palestinian colleagues learn to do this technique the best way possible,” said Dr Eidelman.

Clubfoot occurs in about 150,000-200,000 babies each year worldwide, and is more prevalent among those of black African ancestry. The condition results from the abnormal development of the muscles, tendons, and bones in the foot while the fetus is forming during pregnancy. Both genetic and environmental factors are thought to play a role in the disability’s cause. Clubfoot is about twice as common in boys than girls, and occurs in both feet about 50% of the time.

“From Hippocratic times to the present, club foot has been treated with operations, which had a major drawback: where there was scar tissue, there was no movement,” said Dr Eidelman. “If correctly done, the Ponseti method of manipulation and plaster cast applications is successful in treating clubfoot using minimal or no surgery.

Treatment should begin in the first week or two of life to take advantage of the elasticity of the tissues that form the ligaments and tendons in the foot. ”

The technique was developed in 1950, by Dr Ignacio Ponseti, a Spanish doctor who fled the Franco regime to Iowa, USA. Today, it is the most widespread treatment for this disability

Using the Ponseti method, children with typical clubfoot are fit with a series of five leg casts over four weeks. Those with atypical and complex clubfeet may require a larger number of casts. In addition, some 80% of infants require an Achilles tenotomy, a microscopic incision in the tendon, which is performed in a clinic, under local anesthetic and with no stitches.

Dr Jose Morcuende, the American expert who led the workshop and worked with Dr Ponseti at the University of Iowa, stated that the workshop was tremendously important. “When parents have a child with a difficult defect, they don’t turn to politicians to solve their problem,” he said. “No matter where they’re from, they seek out the doctor. Medicine is above politics – this is part of the medical oath we take. The bottom line is that we are all here to help children.”