SHOOTING STAR: Two-year-old James Little is benefiting from the revolutionary Ponseti Method for treating clubfoot
SEE that little guy there on the right, kicking the football? That's my boy. I know I'm biased but I think he's got a hell of a left foot on him. Who knows, maybe he'll play for Scotland one day.
The thing is, James was born with a clubfoot. Horrible word, isn't it? And it certainly filled my wife and me with fear when we first heard it. It's a word that conjures some pretty grim images of cruelly deformed feet, and of poor souls we've all seen hobbling along the streets.
The word clubfoot is, in fact, rarely used by British medics these days. They prefer the more palatable 'talipes', which is from the Latin words for ankle and foot. This more accurately describes the condition, in which the foot is actually often physically normal – except that it is pointing the wrong way, inwards at the ankle towards the other foot. No one really knows how it happens, though it seems to be genetic. And it is rare – though, with one in 950 newborns affected, 50 to 60 Scots babies are born with clubfoot each year. Some unfortunates have both feet affected.
Until recently, sufferers faced years of painful operations to force the foot to face the right direction. Even after successful surgery, many were left with limps and stiff, inflexible joints which gave them chronic arthritic pain by the time they were in their 30s. It's not a very pleasant prognosis, and my wife and I were distraught when an exceptionally sharp-eyed obstetrician spotted James's errant foot in a prenatal scan.
Fortunately, the name for clubfoot isn't the only thing that has changed in recent years. Today, increasing numbers of doctors use a technique which can turn a clubfoot the right way and make the joint fully flexible and pain-free – and all without surgery. Amazingly, this revolutionary technique was pioneered 50 years ago but has only now become the recognised best treatment for the condition.
Born in Menorca in 1914, Ignacio Ponseti fled the Spanish Civil War for America, where he became an orthopaedic surgeon. In the 1950s this remarkable man became tired of seeing a succession of children living with rigid, painful feet after surgery. So he devised a method of manipulating the feet into position via a series of plaster casts and devices. He worked in near-isolation for decades, his innovative work dismissed by doctors who preferred the quick fix of surgery.
It was only in the 1990s that the medical world started to wake up to what became known as the Ponseti Method. By then, his first patients were in their 30s and 40s – and they were more mobile and suffered less pain than those patients who had undergone traditional surgery. Ponseti came out of retirement to preach the gospel of his method (today, aged 93, he still carries out twice-weekly clinics in Iowa).
Two and a half years after James was born, I am hugely grateful to Ponseti and the growing band of disciples who spread the word. We were lucky to be referred to Yorkhill Hospital in Glasgow, where orthopaedic surgeon Rod Duncan was one of the first Scots to use the new method. "The key paper describing the 30-year follow-up of some of Dr Ponseti's patients was published in 1995," says Duncan. "They compared those who had been treated for clubfoot using his method with normal subjects, matched for age and sex, who had never had any problem with their feet. They found that as far as function, foot pain and movement are concerned, the groups were pretty similar. I had read Dr Ponseti's original description of his method before but these results were astonishingly good, and remain better than any series of patients treated with surgery."
Just three days after he was born, James was put in his first, full-leg plaster cast, which turned his twisted foot a few degrees outwards. A week later, he was back at Yorkhill to have that cast removed and another put on, this time turned a few more degrees to the left. This went on for six weeks, by which time his foot was in the correct position. But this was just the start.
For the next 12 weeks James wore little white boots which were attached at the sole to a metal bar which kept his feet in a rigid position – the left overcompensated outwards at 70û to straight ahead, the right at a more normal 40û. These had to be worn 24 hours a day, removed only for baths. Looking back on it, I can't believe the little boy who now spends all day in a maelstrom of movement was able to put up with it. But he did, and he did it with admirable stoicism. He is now – just – putting up with stage three of the Method, which involves wearing the boots and bar only at night. As prescribed by Ponseti, this will go on until he is four.
Sometimes I wonder how we, as parents, put up with it too. Most nights' sleep are broken at least once as James wakes and is frustrated at being unable to turn or move his feet.
"The parents' co-operation is absolutely essential," says Duncan. "After the casting phase, you are handing the care of the child over to the parents. If they don't do what is asked of them, the boots will not be accepted by the child and the treatment will fail. If the child doesn't wear the boots and bar as prescribed, the treatment doesn't work."
Some Ponseti practitioners have looked at ways to relieve this, notably Dr Matthew Dobbs, who studied under Ponseti and now heads the Clubfoot Center at St Louis Children's Hospital, Missouri. He has devised a new type of bar that allows patients greater movement and makes their lives more bearable. In an early study it has increased the success rate of sticking with the boots from around 60% with standard bars to 98% – though Dobbs insists more work needs to be done on these and other advances.
"We are continuing our research with hundreds of families," he told Spectrum. "The study of genetics is particularly interesting. Our ultimate goal is to identify different types of clubfoot. That should lead to tailored treatment, with some children just needing to wear boots for a year or two, maybe less. That will make life so much more tolerable for them."
And for their parents too.
• For more information, see
www.clubfoot.co.uk and
www.steps-charity.org.ukThe full article contains 1121 words and appears in Scotland On Sunday newspaper.
