Ignacio V. Ponseti, MD

AAOS Now

Published 12/1/2007
|
Jennie McKee

Researcher, mentor, inventor, healer

At 93, Ignacio V. Ponseti, MD, continues to serve patients

“Throughout my life, I have had good luck,” said Ignacio V. Ponseti, MD, during a speech at his 90th birthday party celebration at the University of Iowa.

Although Dr. Ponseti may credit good fortune with giving him the opportunity to train under orthopaedic luminaries and leading him to the University of Iowa, his friends, colleagues, and patients say that his remarkable life and achievements are the result of anything but chance. His commitment to developing a groundbreaking, nonsurgical method for treating clubfoot, his successful efforts to advance the field of orthopaedics, and his generosity in sharing his time and knowledge with others have made him a legend in pediatric orthopaedics.

Beginnings in Spain
Born in 1914 on the Spanish island of Menorca, Dr. Ponseti entered the University of Barcelona at age 16 and earned degrees in biology and medicine.

One day after he graduated from medical school in 1936, the Spanish Civil War began and Dr. Ponseti joined the republican forces. As a battlefield physician, he used the “closed plaster treatment” to treat hundreds of open fractures. After washing and débriding the wound, excising necrotic tissue, and denuding bone fragments and foreign matter, Dr. Ponseti would manually reduce the fracture, pack the wound with sterile gauze, and immobilize the limb in a circumferential plaster dressing. The highly successful treatment saved many soldiers from having their limbs amputated.

As nationalist victory loomed in 1939, Dr. Ponseti fled to France and then immigrated to Mexico, where he treated patients in the village of Juchitepec, south of Mexico City. Finally, in 1941, Dr. Ponseti came to Iowa to finish his residency.

“For me,” said Dr. Ponseti, “to come to Iowa City was a stroke of good fortune, for finally I found myself at home.”

Establishing a foundation in biology
Although best-known for his pioneering treatment of clubfoot (see “Ponseti method revolutionizes clubfoot care,” page 12), Dr. Ponseti has made other significant contributions to orthopaedic surgery. Since 1942, he has published more than 120 scientific papers on clubfoot and conditions such as developmental hip dysplasia, Perthes disease, skeletal dysplasia, and scoliosis. A cofounder of the Orthopaedic Research Society, Dr. Ponseti has also been an advisor to the National Institutes of Health and an editorial board member for leading orthopaedic journals.

Early on, he understood the importance of tissue biology and endeavored to give orthopaedics a firm foundation in biology. Along with Ernst Freund, MD, he helped to establish the orthopaedic pathology program at the University of Iowa. He developed one of the first connective tissue biology and biochemistry laboratories, aimed at discovering the causes of skeletal deformities, including scoliosis and dwarfism. His pioneering studies of the effect of aminonitriles on collagen cross-linking laid the foundation for much of the current understanding of collagen biochemistry and matrix biology.

“Dr. Ponseti published scientific papers in the 1950s that explored the biochemistry of bone and cartilage,” said colleague José A. Morcuende, MD, PhD. “At that time, physicians were just using plaster casts for treatment and were focused only on getting fractures to heal.”

An advisor, teacher, and inspiration
As a teacher and mentor, Dr. Ponseti has influenced many young physicians at Iowa, where he’s had a long and distinguished career.

“When I was a medical student, Dr. Ponseti was my advisor,” said Joseph A. Buckwalter, MS, MD, now professor and head of orthopaedic surgery at Iowa. “He helped me see orthopaedics as a field of great opportunity, as our understanding of the biologic processes responsible for disorders of the musculoskeletal system advanced. Not a day passes that I do not think of him and rely on his teachings.”

Dr. Ponseti also served as a mentor for former AAOS president Stuart L. Weinstein, MD. Dr. Weinstein’s plans to become a gastroenterologist changed when he took an elective course in orthopaedics and met Dr. Ponseti.

“I saw not only a master surgeon, but a scientist and a teacher,” said Dr. Weinstein. “From the beginning, I wanted to be like him because of his caring manner and his continuing quest to understand the fundamentals of disease affecting children. As we proposed treatments, he made certain that we knew the pathoanatomy of the condition, its natural history, how treatments affect outcomes, and how patients and their families perceive treatments.”

Continuing the mission
At age 93, Dr. Ponseti still treats patients with clubfoot three days a week at Iowa’s Ponseti Clubfoot Treatment Center. Many parents travel long distances with their children to see Dr. Ponseti and his colleagues, including Dr. Morcuende, Dr. Weinstein, and Frederick R. Dietz, MD, all of whom Dr. Ponseti trained decades ago.

“It’s wonderful to see patients coming through the clinic,” said Dr. Weinstein. “They come with despair and tremendous anxiety. That turns to love and gratitude after the first cast is removed, and an almost-disbelief at the success of the treatment.”

Reflecting on his patients and his legacy, Dr. Ponseti said, “It has been touching to me to witness how parents know from the first manipulation and removal of the first cast that their baby’s feet are on the way to normality.”

After half a century, his technique is being introduced throughout the world, and his book, Congenital Clubfoot: Fundamentals of Treatment, has been translated into several languages.

“The Ponseti method is as important as the polio vaccine—it has had the same kind of impact on patients’ lives,” said Dr Morcuende.

Dr. Weinstein agrees.

“Although all physicians contribute to medicine in different ways, few of us make the kind of contributions Dr. Ponseti has,” said Dr. Weinstein. “He helped change one aspect of medicine, the treatment of clubfoot, for thousands of patients now—and hundreds of thousands of patients in the future.”

For more information
To learn more about Dr. Ponseti and the Ponseti method, visit
http://www.ponseti.info

Jennie McKee is a staff writer for AAOS Now. She can be reached at mckee@aaos.org