Compassion Fuels Clubfoot Innovations

Innovation often makes our lives easier.


Innovation, though, at its best, makes our lives better.


And as we’ve entered perhaps a Golden Age of technological improvements, one medical innovation has come to be known as the gold standard in its field.


Dr. John Herzenberg exemplifies the curiousness of a medical doctor with the compassion to do good. The current head of pediatric orthopedic surgery at Sinai Hospital of Baltimore has been a leading researcher for correcting clubfoot. The malady affects approximately one in every 1,000 live births. It is a congenital deformity in which the foot rotates.


Exactly 20 years ago, Dr. Herzenberg read a book by clubfoot pioneer Dr. Ignacio Ponseti, Congenital Clubfoot, Fundamentals of Treatment. Ponseti had by then spent three decades developing a treatment method that revolutionized the field. The two doctors developed a friendship and a year later, met in Baltimore, where Ponseti announced that Herzenberg’s success rate with infants was the first time someone not directly trained by Ponseti had used the technique “as it was meant to be done.”


The result has been a life now open to vast possibilities by those treated by Dr. Herzenberg. NPR reported in 2014 on patients directly helped by the method.


“Mary Snyder found out at her 19-week ultrasound that her unborn baby had clubfoot. Both of the fetus's feet were completely turned inward, forming the twisted U-shape typical of clubfoot.


“’It was terrifying,’ remembers Snyder, who lives in Towson, Md. ‘It was very emotional. We did a lot of testing and everything to make sure she was going to be OK, but you never really know until you see them when they're born.’


“Alice, who is now 6, has a checkup every year with Dr. John Herzenberg, an orthopedic surgeon at Sinai Hospital in Baltimore. Alice happily follows the doctor's instructions, walking back and forth across the exam room, then on her tippy toes, and finally with her feet turned out like a duck.”


For Dr. Herzenberg, the individual successes are sublime. He reflects on the progression of treatment methods.


“In the past, before I learned Ponseti, guaranteed I would literally have had to do a surgical operation to take apart and put together the entire foot."


He attributes the dramatic improvement in treatment to Ponseti:


"People were falling over themselves to do fancy invasive surgery, and this one strange old guy who speaks softly with a Spanish accent in Iowa was getting sort of ignored by the drumbeat of people who were in favor of surgery.”


As a revolutionary breakthrough for clubfoot patients, The Ponseti Method utilizes a non-surgical process, developed by Ponseti in the 1990s. The method employs a series of casts that gradually move the foot to the correct position. Weekly, the cast is removed and replaced with a new cast.


After the six-week-to-two-month casting period, the patient’s feet are placed in proper position using a foot abduction brace also known as an AFO or anke-foot orthotic. The patient is required to wear the brace 23 hours a day, for three months. The final stage then requires the brace to be worn, only at night, for four years. This will ensure the procedure corrects the problem.


As is usually the case with daring innovation, Ponseti (who died in 2009, at 95) considered the improvements a team effort.


An invaluable member of that team has been MD Orthopaedics, established in 2003 by John Mitchell, an Iowa-based designer of medical instruments and models. Ponseti and Mitchell formed a dynamic team, and today MD Orthopaedics is a trendsetter in the field.


Ponseti, working at the University of Iowa Hospital, had developed a casting system that revolutionized treatment options.


As Ponseti further developed his method, he discovered that some of the shoes used were impractical, and this is where John Mitchell entered the picture. Mitchell, an Iowa businessman, specialized in molded plastic medical models.


Mitchell worked with Ponseti for a few years, and their trial-and-error process finally produced a shoe model—in reality a sandal with three straps across it—that made the overall device much easier to use.


Ponseti and Mitchell worked closely to create what is now the standard procedure for clubfoot: combining the non-surgical “Ponseti Method” with a new AFO (ankle and foot orthosis) that can be fitted to a small child’s feet for maximum comfort and effect. Mitchell’s design allows the manipulation process of the feet to continue unabated, while lessening drastically relapses in the deformity.


MD Orthopaedics hears routinely from parents whose children have been spared a life spent with difficulty in walking. One mother in New Jersey wrote, saying, “I am so thankful every day for these shoes.”


Ponseti himself understood the role played by Mitchell:


“Mr. John Mitchell has developed the Ponseti AFO which consist of a well-moved plastic footplate and three soft leather straps.  The foot is held securely to the footplate and there is no slippage. The babies do not require a period of adjustment but accept the brace readily.  We have received numerous e-mails from parents around the world praising Mr. Mitchell’s product.”


And in the spirit of collaboration and innovation, we see the successes fueled by the likes of Dr. Herzenberg, John Mitchell, and Ignacio Ponseti.


Well done, gentlemen.