Re: 's Dr. Ponseti Essay REVISED.doc

September 6, 2005

ee,

That is beautiful! I am crying over here! I saw a few typo's, but am on my

way to work right now.

Please add our names to the list...

& Consider of Pennsylvania, parents of one clubfooted

daughter, Olivia, who has perfect feet after treatment by Dr. Ponseti. We

begged and borrowed to go to to Iowa after 4 months of failed traditional

casting and three different doctors telling us surgery was the only answer.

Those doctors were wrong.

Well done ee!!

Jen & Olivia

's Dr. Ponseti Essay REVISED.doc

, and Everyone,

here is the email version for the Life Time Achievement Award Essay -

(I'll send an attachment version also for easier printing and/or editing if

you choose). I hope this is somewhere with in a hundred miles of what you

were anticipating. I asked Joyce Roller for more specifics but have not

heard from her, so I went with what I had and am sending it before you think

I'm blowing off my assignment here. Actually, ask my husband, I've lost a

lot of sleep, such a responsibility, such an important undertaking!

If it sucks I'm not offended if you scratch it out and start from scratch.

Woven throughout you will notice I used your key points. Likewise, if there

is any mis-information that needs corrected by all means bring it to my

attention, or if anyone has information prudent to the cause that I totally

over looked, that too should be brought forth! Because there was not a page

limit / word limit, I did not limit myself or even attempt to. It's double

spaced and justified for easier reading. Nor did I bring a case history of

any particular patient in to it, aiming to be objective and factual, yet

tell the story in such a way as to convey the man's compassion and the

legitimacy of this birth defect. I told it from the standpoint of " We the

parents of children born with clubfoot " ....I do not mean to exclude those

here who are now adults who were born with clubfoot, but the objective is to

spread the word that new born babies will not endure the tortures of

misinformed doctors using out dated treatments.

And with all that as my disclaimer, sitting here insecurely as I toss out

my wares for inspection, here is the actual essay as it sits on my desk

tonight.

Blessings to all,

ee

Dr. Ignacio Ponseti Lifetime Achievement Award Essay

by: ee Reese

September 2005

Five years after the Spanish military initiated an uprising against their

own Republican government sparking years of Civil War, lin D. Roosevelt

made his historic 3rd Inaugural Address to the Nation, Pearl Harbor was

obliterated, the famous Infamy Speech was delivered, and the United States,

having already suffered twelve years of economic collapse on the heels of

fighting World War I, entered World War II.

The year was 1941.

It was the year a young man immigrated to America from Spain to escape

the post civil war ravages in his homeland.

Historians suggest the Spanish Civil War which ejected this young doctor

on to American shores was merely a prelude to the World War that he traveled

across the Atlantic Ocean in effort to escape. They further suggest the

Spanish war was a testing ground, implying the bombing of Guernica promoted

advances in twentieth-century warfare techniques and technology.

Fortunately, this era brought forth amazing advances in medical technique

and technology as well - which also came from Spain.

His name was Ignacio Ponseti. He came to America an immigrant, a young

doctor escaping a war torn country to enter a country that was engaging into

a war of epic proportions that very same year. It was a small world after

all.

Ultimately he arrived at the University of Iowa College of Medicine where

his assignment was to perform certain follow up studies on patients who had

been treated for clubfoot according to the " modern " medical standards of

that time. Disappointed with his findings, the young doctor dedicated his

life to finding a better way to cure this crippling birth defect.

Only seven years after his arrival to the United States, post war America

was a very different place. Luxury automobile owners were sporting the

newly invented electric car windows. Art Mooney was topping the charts with

his hit song I'm Looking Over A Four Leaf Clover; and fittingly with this

new-found era of American prosperity, our young Dr. Ponseti achieved his

goal. In 1948, through his years of dedicated hands on treatment and

research, he discovered, then refined, his non-surgical method for

correcting clubfoot.

The glory of his work is that children no longer have to undergo painful

surgeries that most often result in a life time of painful feet and

subsequent surgeries.

The horror is that fifty-seven years after developing his method, the

medical community at large continues to practice according to the same

techniques they used half a century ago when he started, ignoring the

Ponseti Method despite his decades of follow up studies proving its 95%

effectiveness rate when performed properly.

In 1941 he was a Spanish Immigrant. Today, he is Professor Emeritus

Orthopaedic Surgery at the University of Iowa College of Medicine. The

doctor, and his method, remain one of the world's best kept secrets as the

medical community continually refuses to adopt or even recognize the

validity of his method.

As the parents of children born with this vulgar, crippling, congenital

birth defect, we consider this unacceptable.

When he was 70 years old the University of Iowa, where he still

practiced, forced Dr. Ponseti to retire. Two years later, he convinced the

University to take him back despite his 'advanced' age. He continued to

perform his miracle on otherwise crippled babies for the next fourteen

years.

When he was 84, he once again headed in to retirement - then the internet

happened. Word of his non-surgical method began to spread. As parents

discovered they had a choice, they began to travel from across the USA and

from across the ocean seeking out his method for their children. Today,

twenty years after the University tried to force him to quit, parents are

still traveling to see him, or one of his few qualified associates. And

finally, after fifty odd years of dedicated service, the University of Iowa

Hospital finally recognized Dr. Ponseti's contribution to both their

facility and the medical field by naming a branch of their clinic after the

man who has given his life to giving children happy feet.

Word continues to spread by mouth and internet about this astonishing,

dedicated man and his incredible journey that started half a world away a

half a century ago, but as the parents of children born with clubfoot we

face two major obstacles.

First, to be completely candid, time is ticking. Dr. Ponseti will

celebrate his 91st birthday in June of this year (2005) yet he continues to

serve parents and babies in his clinic at the University of Iowa - the

oldest of hands gently repairing the youngest of patients.

" Do not cry, Baby. " The gentle, quiet words roll off his tongue in a

thick Spanish accent that immediately begins to sooth the anxious child with

their music. " If you cry, then I will cry, and then my nurse will cry and

then your Ma'Ma will cry. We will all be crying! Do not cry, Baby. " and

turning to the mother, " Here Ma'Ma, take your baby, comfort him, I will not

work on a crying baby, let him calm down. " He points to the old rocking

chair where he so often sits to do his exams. The mother rocks her baby.

The room smiles. The mother, the father, the nurses, the students, and Dr.

Ponseti, the 90 year old doctor pauses in his work for as long as it takes

as if this infant is the only infant in the world and time has stood still

for it.

He continues to teach any doctor willing to learn; he consults daily via

email and telephone not only with other doctors, but personally answering

the calls of distraught parents and sorting through the photos and videos

parents send showing their baby's feet at various stages of various

treatments. He turns no one away.

" You must come right away. " He is on the phone answering the email plea

sent with digital photos of a 19 month old boy with deformed feet despite a

year and a half of treatments and physical therapy. " I can help " , says the

doctor, " but there is no time to be lost, you must come right away. You get

here and I will see you. "

Because of the previous nineteen months of substandard treatment this

child will never be completely corrected nor ever know what it means to have

pain-free feet despite Dr. Ponseti's best efforts. But though his efforts,

another believer is born, who spreads the word of his miracles so no other

child has to endure what her son must endure.

Slowly, through the efforts of parents like us spreading the word and

insisting we have alternatives to surgery, the list of qualified Ponseti

Method physicians is growing annually. But time is ticking and the method

is at risk of being lost forever.

The second obstacle we face is the medical world, sadly enough. Through

the internet the term Ponseti Method has gained popularity, even if the

actual method has not. Suddenly the clinics are flooded with cheap

imitations throwing around the words " Ponseti Method " although they are not

practicing the Ponseti Method in any true form. These doctors are not

skilled in the method, they have received no formal training, and

unfortunately, most parents don't know the difference until it is too late,

until they can no longer deny their child is not getting any better and may

in fact, be getting worse. So they finally do their own research. They

finally make that call, and Dr. Ponseti says to come right away, because he

always says come right away, because he always holds out hope to the very

end. Because every baby becomes his baby.

But these children do not always arrive in time to be rescued from their

horrible fate, because while clubfoot is nearly 100% correctable, there is a

limited window of opportunity that allows the miracle to take place. Once

the window is closed, the basic human anatomy of the foot no longer lets a

non-surgical correction happen. And if the baby arrives to Ponseti's care

too late, that baby will forever suffer the consequences of inadequate care.

With so many unqualified doctors suddenly claiming to use the Ponseti

Method, yet doing something quite different, the results are predictably

disastrous. Thus we risk that the method will be eventually proven

ineffective as these results are published and the public and medical

communities combined rally against the Ponseti Method for it's

ineffectiveness with out realizing this lack of success is not due to the

method not working, but due to gross and incompetent misuse of the method by

untrained physicians.

And when the that happens, the method will be lost forever. There are

already claims that Ponseti's method is only perhaps 70, 60 or 50%

effective - when in fact, qualified doctors who use the method according to

the protocol are consistently achieving 95% success rates year after year

after year.

And again we say, as the parents of babies born with this ugly, crippling

birth defect, this is completely unacceptable.

So how do we know? How is a parent who has just been dealt the crushing

news their baby has a major birth defect supposed to know the difference

when any doctor who has heard of clubfeet is suddenly proclaiming to be

advanced in the method of treating either though Ponseti's method or more

traditional modes? When a baby is born with a birth defect, and one as

physically ugly as clubfoot often is, a parent is eager to relieve their

own sense of guilt and their child's suffering. They often are so eager

they blindly trust the local doctor - after all, he's a doctor, he should

know. And when we ask, when we finally get around to noticing something is

wrong and we ask, we are riddled with long technical answers that leave us

feeling inferior and confused and ashamed of ourselves for questioning his

superiority. So how do we know what to do?

Through public awareness like this, for starters.

In traditional treatments, the infant is often put through months of

serial casting where their foot is manually wrenched in to a normal looking

position and casted in to that shape as it grows. As recent as the 1960's,

Dr. Dennis Brown writes that he used mechanical devices to wrench the foot

in to position prior to casting. Somehow, the Foot Abduction Brace (FAB)

which is used in the Ponseti Method became known popularly as the Dennis

Brown Bar, or DBB. (We call it the FAB, wanting no association between Dr.

Ponseti's gentle care and the horrific mechanical tortures used by Dr.

Brown.)

At the end of all this the child almost always undergoes corrective

surgery anyway because the bones remain misaligned. The surgery involves

taking the foot apart and reassembling it to look normal on the outside even

though it has been grossly disassembled and remains deformed on the inside.

The result is the bones are not allowed to grow naturally as they should;

scar tissue builds up; joints stiffen; tendons are unable to stretch; more

surgeries become necessary to loosen a tendon, to scrape out scar tissue, to

add steel pins or remove steel pins. And still the foot remains misshapen

and painful to use, often not fitting in any type of regular shoe.

The only thing the Ponseti Method has in common with the traditional

method of treatment is the term Serial Casting, which implies a series of

casts are applied to the child. In the 1940's Dr. Ponseti discovered what

all the others had overlooked - the delicate infrastructure of the foot and

the logical, sequential placement of it's twenty-six bones. The bones in a

clubbed foot are all there, they're really OK, but like a jigsaw puzzle,

they come mixed up in the box and need put back together to make the final

picture. Traditional methods of correction do not account for this.

Traditional thinking seems to believe the bones are wrong, that the bones

need fixed. But they aren't wrong, and they don't need fixed, they just

need gentle hands and careful eyes placing them in the correct spot like the

intricate puzzle they are - not sawed upon to fit where a doctor wants them

or crammed in to positions where they were not intended by nature to fit.

Treated properly by the Ponseti Method, the tiny new born bones are very

gently, slowly and methodically manipulated by gentle hands in to their

proper alignment where they are expertly casted in to place for a period of

five to seven days. Again and again the process is repeated over the course

of approximately five weeks - each bone individually identified, placed in

its necessary position according to a certain sequence of movements, and

casted in to place, maintained for approximately a week as the foot adapts.

Most infants sleep through the process as the doctor finds the correct

bones and moves them carefully, and always sequentially, in to their proper

position (compared to the physical restraint babies require using other

methods). Others eat or play. And almost none cry, because it is neither

frightening nor painful. No drugs are given, no shots, no restraints, the

parents are always present, holding or other wise comforting the baby, and

if fear does creep in and cause the child anxiety, the process is stopped

until the baby is again feeling calm and secure because an anxious child

will be tense, and tense bones and muscles cannot be properly aligned

anyway. So the whole Ponseti Method rests largely on maintaining a calm,

happy baby though the correction process. The entire visit is usually over

with in less than a half an hour.

While we don't want Ponseti's method mixed up with any new-age mentality

that it ranks with acupuncture, herbs, aroma therapy or the beating of drums

during the twelfth hour of the full moon as Venus enters the shadow of

ars - neither does this method belong to the ranks of sterile surgical

rooms, recovery rooms, antibiotics, stitches, face masks, needles, tubes or

electronic monitoring devices.

Completely scientific, completely proven, completely safe and effective,

the Ponseti Method is a very gentle and organic procedure saving children

from their crippling condition.

The average infant born with clubfoot has corrected, fully functional feet

with in five to seven weeks of serial casting when the casting is performed

in this manner. In other words, this child treated correctly by the Ponseti

Method will have normal feet before he is ever old enough to realize they

were missing in the first place.

When the manipulation of the bones is complete, the infant is moved out

of casting and in to the Foot Abduction Brace (FAB) - a small pair of baby

booties connected by a bar that runs between them. Set at very specific

degrees and measurements to match each individual infant, the baby wears

this brace for 23 hours a day for the first three months of use. From there

the amount of time the baby wears the brace is gradually reduced to

approximately twelve to fourteen hours of wear - bed time - as the bones

grow and experience their natural hardening process. Unlike the

unfortunate children who might wear the casts for six to twelve months in

the traditional methods, babies who wear the FAB are not delayed in

development. They can roll over, crawl, and eventually cruise with the FAB

on their feet meeting every milestone on time. They still fit in to normal

cloths, cribs, high chairs and car seats with the FAB on their feet, it

becomes only a small extension of the child, for a small part of their life.

By the end of the treatment period, the feet have grown, the bones have

hardened as they do, and the correction is now maintained simply by the

natural growth and exercise of the foot. Because no bones were cut,

lengthened or shortened, no pins were surgically inserted, no tendons were

cut, no muscles were peeled back to expose the bones for surgery - there is

nothing to heal, nothing to infect, and nothing to malfunction. The entire

foot can now grow and function completely normally for the rest of that

individual's life.

No surgical theaters. No anesthesia. No pain killers. No antibiotics. No

hospital stays. No IV's. No starving the infant for hours prior to the

operation. No separation of the infant from his parents. Reduced cost of

treatment. Ninety-five percent success rate. The promise of normal,

natural feet. No ugly scars on the outside of the skin, or crippling scar

tissue growing on the inside. Fifty years of use and follow up studies to

back it.

And still, no one wants to listen.

And still, as the parents of children born with clubfoot, as citizens in

the most medically advanced nation on this earth, we find surgical treatment

of clubfoot not only barbaric, but irresponsible, negligent to the extent of

malpractice...and completely unacceptable.

Why then will no body listen?

Because we're talking about feet? Because there is no drama to a

non-surgical method? Ask the parents of children born with clubfoot if

their child's birth defect lacks drama.

According to the March of Dimes:

Neural Tube Defects (NTDs) affect 1 per 2,000 births.

Down Syndrome ranks at 1 in 800 births.

Sickle Cell Anemia affects from 1 in 500 to 1 in 1000 depending on racial

factors.

Cleft Palate affects 1 in 1000.

And Clubfoot is calculated to affect 1 in 735 births annually in the

United States, with higher rates abroad.

It can be estimated by 2002 population figures that Clubfoot affects

approximately 4,000 to 5,000 American newborn babies each year. More than

Neural Tube Defects. More than Down Syndrome. More than Cleft Palate.

More or the same as Sickle Cell Anemia

Even the March of Dimes remains unaware as their website suggests as many

as 50% of the infants born with Clubfoot will require a surgical correction;

that's forty-five percent more surgeries than necessary. The Ponseti Method

averages a low 5 percent surgical rate.

But these are feet we're talking about, right? Who wants to pay any

attention to feet when there are much more exciting and dramatic (although

less prevalent) birth defects to talk about?

Why talk about a non-surgical medical procedure when there are much more

colorful, gruesome, theatrical surgeries to broadcast? Blood sells, right?

Images of oxygen masks, heart monitors, teams of doctors in their frocks

hunched over a patient who is cut wide open? Or a condition with no known

cure? That's good television. Sick children with no cure in sight.

Twisted feet torturously dissected is good television. A non-surgical

method created by a Spanish Civil War Veteran in 1948 who still practices at

the age of 91 years old - is also good television because behind the

producer who has the guts to broadcast this are 4,000 more babies being born

this year who are at risk of having their feet cut up unnecessarily - and

you could save them.

We are here to nominate Doctor Ignacio Ponseti for the Lifetime

Achievement Award because he has truly given his life to these crippled

babies. His entire adult life, rapidly approaching a century old, has been

dedicated to achieving not personal goals for his own fame and fortune

because if that were the case, he and his method would be world famous by

now! But to achieving a happy life minus the pain of deformed feet for

thousands of babies world wide. Abraham Lincoln said it best, " I can't

think if my feet hurt. " If ever a time in history demanded our future

generations have clear minds to think with, it is now.

If awarded, Dr. Ponseti's wish is characteristically unselfish. When

asked, his only wish was that he be able to contribute more than he already

has, that his work be continued after he is gone though the veins of his

foundation: The Clubfoot Clinic Fund.

This foundation supports research of clubfoot so perhaps the one in a

thousand babies currently born in the US each year with this birth defect

can be diminished if not eliminated completely (scientists believe they have

recently isolated the gene that causes clubfoot); it supports the continued

development of better treatment options such as better casting materials and

better designs of the Foot Abduction Brace; it helps pay for treatments that

otherwise could not be afforded by economically challenged parents; it sends

supplies and braces to the poor and under-developed countries around the

world; it supports bringing in doctors from both America and over seas to

train with Dr. Ponseti and his colleagues in Iowa so they may take the

method home and continue its use; it funds the development of clubfoot

clinics in 3rd world countries where the rate of clubfoot per capita is much

higher than it is here in the US.

Granted his wish, the sky would be the limit. More doctors could afford

to train under Dr. Ponseti; an educated medical community could identify and

eliminate from practice those who are performing the method falsely;

teleconferencing technology could be put in place so doctors world wide

could consult with one another directly, sharing video images, photos,

x-rays, advice, help and ultimately, success. Public awareness in the

general population could be raised so eventually no child will have to

suffer the consequences of treatment that became outdated three years after

their great-grandparents came home from WWII - because through public

awareness, those methods would become as happily obsolete as Art Mooney's

1948 top ten song.

Additionally, although Dr. Ponseti did not request this, we would like to

organize a reunion of his patients, both those who have been treated by his

gentle hands in person, and those who were treated by his method thanks to

the few doctors who have taken the time to learn it. We would like to

publicly honor the man who gave our children back their feet.

We nominate Dr. Ponseti not as a small group of mothers who meet at the

coffee shop with too much time on our hands - but as hundreds, if not

thousands of mothers, and fathers, and grandparents, aunts and uncles and

children young and old who have experienced clubfoot first hand, who have

educated themselves, their friends and their neighbors, who have continued

for years now the daunting task of speaking loudly that the world might

finally listen and finally eliminate the primitive treatments still in use

today on our young babies.

We nominate Dr. Ponseti on behalf of the 45,000 (yes, forty-five thousand)

babies who will be born in the U.S. over the next ten years who will suffer

this birth defect.

It's been close to sixty years. It's time this great American story is

told to the world. It is time the world knew medical science has escaped

the 1940's and moved in to the twenty-first century.

He was an immigrant escaping the Spanish Civil War arriving in America the

year we entered World War II. Now he is a 91 year old doctor who still

walks to work each day to treat his tiniest of patients, because if not Dr.

Ponseti, then who? The world must learn and new young doctors must move in

to fill the shoes, to advance the method, to save the babies.

We, the parents of children born with clubfoot implore you to explore the

rich and colorful life of this silent American icon so he will not only get

the recognition he deserves after half a century of service, but also so no

other baby will have to endure the horrors of having their feet taken apart

and put artificially back together unnecessarily.

If nothing else happens from our attempt to honor Dr. Ponseti with the

Lifetime Achievement Award, one very key thing has happened right before

your very eyes: you, the reader, are now informed.

We the parents of children born with clubfoot have reached one more

person, who will, some day, tell two friends who will, someday, tell two

friends. And thus, the Ponseti Method has survived for half a century one

person at a time - and truly, that is probably the only reward Dr. Ponseti

would ever ask for, that the word be spread, even if by only one mouth and

one ear at a time. He doesn't want awards, he wants to see an end to the

senseless brutality our trusted doctors are inflicting upon our tiniest of

babies. Once that is accomplished, then, maybe then, he will finally feel

it is safe for him to retire and pass his torch to the next generation

trusting we will keep it burning.

Summary and Contact Information:

There are two forms of clubfeet. The first is relatively minor and known

as Positional Clubfoot often due to a lack of amniotic fluid in the uterus

cramping the baby's development. The second is Congenital Clubfeet, it is

considered idiopathic, meaning doctors are not entirely sure what causes it

, but suspect it caused by an unknown genetic factor coming in to play

affecting the baby at approximately 20 weeks post conception. There also

appears to be a slight inheritance factor involved as well, although not

always. Because clubfoot is not present in the early weeks of development

when most ultrasounds are performed, the condition is often not discovered

until the child's birth.

The Ponseti Method of Clubfoot correction is superior to the traditional

method of treatment in that the baby's bones are gently persuaded to move in

to their natural position through a process of systematic serial castings.

No surgeries take place. No bones are cut, broken, or pinned back together.

No muscles or tendons are stripped. No joints are penetrated. The method

is completely non-intrusive. Done correctly the foot is allowed to continue

its natural progression in to adulthood allowing these child to live normal,

active lives.

With correction performed properly by a qualified physician and with the

parent's diligent and dedicated use of the FAB (Foot Abduction Brace),

babies treated by the Ponseti Method enjoy a 95% success rate, i.e., 95% of

the babies will never need a surgical attempt at correction.

For more information about the clubfoot deformity, please contact the

University of Iowa Clubfoot Clinic at (319)356-3469 or visit

http://www.vh.org/pediatric/patient/orthopaedics/clubfeet/index.html for

medical reports, articles, FAQ's, testimonials and photos. Parents or

family members of a clubfooted baby are urged to join the nosurgery4clubfoot

group at Yahoo! groups, nosurgery4clubfoot for advice and

support.

This Nomination is sent to you by the Parents of Children Born With

Clubfoot and the children born with clubfoot who became the victims of

misinformed doctors, as well as the children who have most blessedly been

cured by the life's work of Dr. Ignacio Ponseti - and all the clubfooted

babies yet to come.

Signed and Sincerely,

ee and Chriss Reese of Oklahoma

- parents of two clubfooted sons, who remains somewhat crippled

because we did not know yet about Dr. Ponseti, and Everett who enjoys

perfect feet thanks to Dr. Ponseti.

Harvey and June Reese of Oklahoma

- parents of one clubfooted child, Mark, who remains with crippled feet

because no one knew about the Ponseti Method.

Leroy Reese of Oklahoma

- father of one clubfooted son, Greg, who remains with crippled feet

because no one knew about the Ponseti Method.

Others add your names like this too and grow the list

September 6, 2005

ee, this is great!

I'd love to add my family's names to this as well.

and Houdek of Minneapolis, MN, - Parents of one

clubfooted son, Aleksander, with two beautiful feet thanks to the

Ponseti Method.

> , and Everyone,

> here is the email version for the Life Time Achievement Award

Essay - (I'll send an attachment version also for easier printing

and/or editing if you choose). I hope this is somewhere with in a

hundred miles of what you were anticipating. I asked Joyce Roller

for more specifics but have not heard from her, so I went with what I

had and am sending it before you think I'm blowing off my assignment

here. Actually, ask my husband, I've lost a lot of sleep, such a

responsibility, such an important undertaking!

>

> If it sucks I'm not offended if you scratch it out and start from

scratch. Woven throughout you will notice I used your key points.

Likewise, if there is any mis-information that needs corrected by all

means bring it to my attention, or if anyone has information prudent

to the cause that I totally over looked, that too should be brought

forth! Because there was not a page limit / word limit, I did not

limit myself or even attempt to. It's double spaced and justified

for easier reading. Nor did I bring a case history of any

particular patient in to it, aiming to be objective and factual, yet

tell the story in such a way as to convey the man's compassion and

the legitimacy of this birth defect. I told it from the standpoint

of " We the parents of children born with clubfoot " ....I do not mean

to exclude those here who are now adults who were born with clubfoot,

but the objective is to spread the word that new born babies will not

endure the tortures of misinformed doctors using out dated treatments.

>

> And with all that as my disclaimer, sitting here insecurely as I

toss out my wares for inspection, here is the actual essay as it sits

on my desk tonight.

> Blessings to all,

> ee

>

> Dr. Ignacio Ponseti Lifetime Achievement Award Essay

>

> by: ee Reese

> September 2005

>

> Five years after the Spanish military initiated an uprising against

their own Republican government sparking years of Civil War, lin

D. Roosevelt made his historic 3rd Inaugural Address to the Nation,

Pearl Harbor was obliterated, the famous Infamy Speech was delivered,

and the United States, having already suffered twelve years of

economic collapse on the heels of fighting World War I, entered World

War II.

>

> The year was 1941.

> It was the year a young man immigrated to America from Spain to

escape the post civil war ravages in his homeland.

>

> Historians suggest the Spanish Civil War which ejected this young

doctor on to American shores was merely a prelude to the World War

that he traveled across the Atlantic Ocean in effort to escape. They

further suggest the Spanish war was a testing ground, implying the

bombing of Guernica promoted advances in twentieth-century warfare

techniques and technology.

>

> Fortunately, this era brought forth amazing advances in medical

technique and technology as well - which also came from Spain.

>

> His name was Ignacio Ponseti. He came to America an immigrant, a

young doctor escaping a war torn country to enter a country that was

engaging into a war of epic proportions that very same year. It was

a small world after all.

>

> Ultimately he arrived at the University of Iowa College of Medicine

where his assignment was to perform certain follow up studies on

patients who had been treated for clubfoot according to the " modern "

medical standards of that time. Disappointed with his findings, the

young doctor dedicated his life to finding a better way to cure this

crippling birth defect.

> Only seven years after his arrival to the United States, post war

America was a very different place. Luxury automobile owners were

sporting the newly invented electric car windows. Art Mooney was

topping the charts with his hit song I'm Looking Over A Four Leaf

Clover; and fittingly with this new-found era of American

prosperity, our young Dr. Ponseti achieved his goal. In 1948,

through his years of dedicated hands on treatment and research, he

discovered, then refined, his non-surgical method for correcting

clubfoot.

>

> The glory of his work is that children no longer have to undergo

painful surgeries that most often result in a life time of painful

feet and subsequent surgeries.

> The horror is that fifty-seven years after developing his method,

the medical community at large continues to practice according to the

same techniques they used half a century ago when he started,

ignoring the Ponseti Method despite his decades of follow up studies

proving its 95% effectiveness rate when performed properly.

>

> In 1941 he was a Spanish Immigrant. Today, he is Professor

Emeritus Orthopaedic Surgery at the University of Iowa College of

Medicine. The doctor, and his method, remain one of the world's

best kept secrets as the medical community continually refuses to

adopt or even recognize the validity of his method.

>

> As the parents of children born with this vulgar, crippling,

congenital birth defect, we consider this unacceptable.

>

> When he was 70 years old the University of Iowa, where he still

practiced, forced Dr. Ponseti to retire. Two years later, he

convinced the University to take him back despite his 'advanced'

age. He continued to perform his miracle on otherwise crippled

babies for the next fourteen years.

>

> When he was 84, he once again headed in to retirement - then the

internet happened. Word of his non-surgical method began to

spread. As parents discovered they had a choice, they began to

travel from across the USA and from across the ocean seeking out his

method for their children. Today, twenty years after the University

tried to force him to quit, parents are still traveling to see him,

or one of his few qualified associates. And finally, after fifty

odd years of dedicated service, the University of Iowa Hospital

finally recognized Dr. Ponseti's contribution to both their facility

and the medical field by naming a branch of their clinic after the

man who has given his life to giving children happy feet.

> Word continues to spread by mouth and internet about this

astonishing, dedicated man and his incredible journey that started

half a world away a half a century ago, but as the parents of

children born with clubfoot we face two major obstacles.

> First, to be completely candid, time is ticking. Dr. Ponseti

will celebrate his 91st birthday in June of this year (2005) yet he

continues to serve parents and babies in his clinic at the University

of Iowa - the oldest of hands gently repairing the youngest of

patients.

> " Do not cry, Baby. " The gentle, quiet words roll off his tongue in

a thick Spanish accent that immediately begins to sooth the anxious

child with their music. " If you cry, then I will cry, and then my

nurse will cry and then your Ma'Ma will cry. We will all be crying!

Do not cry, Baby. " and turning to the mother, " Here Ma'Ma, take your

baby, comfort him, I will not work on a crying baby, let him calm

down. " He points to the old rocking chair where he so often sits to

do his exams. The mother rocks her baby. The room smiles. The

mother, the father, the nurses, the students, and Dr. Ponseti, the

90 year old doctor pauses in his work for as long as it takes as if

this infant is the only infant in the world and time has stood still

for it.

>

> He continues to teach any doctor willing to learn; he consults

daily via email and telephone not only with other doctors, but

personally answering the calls of distraught parents and sorting

through the photos and videos parents send showing their baby's feet

at various stages of various treatments. He turns no one away.

> " You must come right away. " He is on the phone answering the

email plea sent with digital photos of a 19 month old boy with

deformed feet despite a year and a half of treatments and physical

therapy. " I can help " , says the doctor, " but there is no time to be

lost, you must come right away. You get here and I will see you. "

> Because of the previous nineteen months of substandard treatment

this child will never be completely corrected nor ever know what it

means to have pain-free feet despite Dr. Ponseti's best efforts. But

though his efforts, another believer is born, who spreads the word of

his miracles so no other child has to endure what her son must endure.

> Slowly, through the efforts of parents like us spreading the word

and insisting we have alternatives to surgery, the list of qualified

Ponseti Method physicians is growing annually. But time is ticking

and the method is at risk of being lost forever.

>

> The second obstacle we face is the medical world, sadly enough.

Through the internet the term Ponseti Method has gained popularity,

even if the actual method has not. Suddenly the clinics are flooded

with cheap imitations throwing around the words " Ponseti Method "

although they are not practicing the Ponseti Method in any true form.

These doctors are not skilled in the method, they have received no

formal training, and unfortunately, most parents don't know the

difference until it is too late, until they can no longer deny their

child is not getting any better and may in fact, be getting worse.

So they finally do their own research. They finally make that call,

and Dr. Ponseti says to come right away, because he always says come

right away, because he always holds out hope to the very end.

Because every baby becomes his baby.

> But these children do not always arrive in time to be rescued from

their horrible fate, because while clubfoot is nearly 100%

correctable, there is a limited window of opportunity that allows the

miracle to take place. Once the window is closed, the basic human

anatomy of the foot no longer lets a non-surgical correction happen.

And if the baby arrives to Ponseti's care too late, that baby will

forever suffer the consequences of inadequate care.

> With so many unqualified doctors suddenly claiming to use the

Ponseti Method, yet doing something quite different, the results are

predictably disastrous. Thus we risk that the method will be

eventually proven ineffective as these results are published and the

public and medical communities combined rally against the Ponseti

Method for it's ineffectiveness with out realizing this lack of

success is not due to the method not working, but due to gross and

incompetent misuse of the method by untrained physicians.

>

> And when the that happens, the method will be lost forever. There

are already claims that Ponseti's method is only perhaps 70, 60 or

50% effective - when in fact, qualified doctors who use the method

according to the protocol are consistently achieving 95% success

rates year after year after year.

>

> And again we say, as the parents of babies born with this ugly,

crippling birth defect, this is completely unacceptable.

>

> So how do we know? How is a parent who has just been dealt the

crushing news their baby has a major birth defect supposed to know

the difference when any doctor who has heard of clubfeet is suddenly

proclaiming to be advanced in the method of treating either though

Ponseti's method or more traditional modes? When a baby is born with

a birth defect, and one as physically ugly as clubfoot often is, a

parent is eager to relieve their own sense of guilt and their

child's suffering. They often are so eager they blindly trust the

local doctor - after all, he's a doctor, he should know. And when we

ask, when we finally get around to noticing something is wrong and we

ask, we are riddled with long technical answers that leave us feeling

inferior and confused and ashamed of ourselves for questioning his

superiority. So how do we know what to do?

>

> Through public awareness like this, for starters.

>

> In traditional treatments, the infant is often put through months

of serial casting where their foot is manually wrenched in to a

normal looking position and casted in to that shape as it grows. As

recent as the 1960's, Dr. Dennis Brown writes that he used mechanical

devices to wrench the foot in to position prior to casting. Somehow,

the Foot Abduction Brace (FAB) which is used in the Ponseti Method

became known popularly as the Dennis Brown Bar, or DBB. (We call it

the FAB, wanting no association between Dr. Ponseti's gentle care and

the horrific mechanical tortures used by Dr. Brown.)

> At the end of all this the child almost always undergoes corrective

surgery anyway because the bones remain misaligned. The surgery

involves taking the foot apart and reassembling it to look normal on

the outside even though it has been grossly disassembled and remains

deformed on the inside. The result is the bones are not allowed to

grow naturally as they should; scar tissue builds up; joints stiffen;

tendons are unable to stretch; more surgeries become necessary to

loosen a tendon, to scrape out scar tissue, to add steel pins or

remove steel pins. And still the foot remains misshapen and painful

to use, often not fitting in any type of regular shoe.

> The only thing the Ponseti Method has in common with the

traditional method of treatment is the term Serial Casting, which

implies a series of casts are applied to the child. In the 1940's

Dr. Ponseti discovered what all the others had overlooked - the

delicate infrastructure of the foot and the logical, sequential

placement of it's twenty-six bones. The bones in a clubbed foot are

all there, they're really OK, but like a jigsaw puzzle, they come

mixed up in the box and need put back together to make the final

picture. Traditional methods of correction do not account for this.

Traditional thinking seems to believe the bones are wrong, that the

bones need fixed. But they aren't wrong, and they don't need fixed,

they just need gentle hands and careful eyes placing them in the

correct spot like the intricate puzzle they are - not sawed upon to

fit where a doctor wants them or crammed in to positions where they

were not intended by nature to fit.

>

> Treated properly by the Ponseti Method, the tiny new born bones are

very gently, slowly and methodically manipulated by gentle hands in

to their proper alignment where they are expertly casted in to place

for a period of five to seven days. Again and again the process is

repeated over the course of approximately five weeks - each bone

individually identified, placed in its necessary position according

to a certain sequence of movements, and casted in to place,

maintained for approximately a week as the foot adapts.

> Most infants sleep through the process as the doctor finds the

correct bones and moves them carefully, and always sequentially, in

to their proper position (compared to the physical restraint babies

require using other methods). Others eat or play. And almost none

cry, because it is neither frightening nor painful. No drugs are

given, no shots, no restraints, the parents are always present,

holding or other wise comforting the baby, and if fear does creep in

and cause the child anxiety, the process is stopped until the baby is

again feeling calm and secure because an anxious child will be tense,

and tense bones and muscles cannot be properly aligned anyway. So

the whole Ponseti Method rests largely on maintaining a calm, happy

baby though the correction process. The entire visit is usually over

with in less than a half an hour.

>

> While we don't want Ponseti's method mixed up with any new-age

mentality that it ranks with acupuncture, herbs, aroma therapy or the

beating of drums during the twelfth hour of the full moon as Venus

enters the shadow of Mars - neither does this method belong to the

ranks of sterile surgical rooms, recovery rooms, antibiotics,

stitches, face masks, needles, tubes or electronic monitoring

devices.

> Completely scientific, completely proven, completely safe and

effective, the Ponseti Method is a very gentle and organic procedure

saving children from their crippling condition.

> The average infant born with clubfoot has corrected, fully

functional feet with in five to seven weeks of serial casting when

the casting is performed in this manner. In other words, this child

treated correctly by the Ponseti Method will have normal feet before

he is ever old enough to realize they were missing in the first place.

>

> When the manipulation of the bones is complete, the infant is

moved out of casting and in to the Foot Abduction Brace (FAB) - a

small pair of baby booties connected by a bar that runs between

them. Set at very specific degrees and measurements to match each

individual infant, the baby wears this brace for 23 hours a day for

the first three months of use. From there the amount of time the

baby wears the brace is gradually reduced to approximately twelve to

fourteen hours of wear - bed time - as the bones grow and experience

their natural hardening process. Unlike the unfortunate children

who might wear the casts for six to twelve months in the traditional

methods, babies who wear the FAB are not delayed in development.

They can roll over, crawl, and eventually cruise with the FAB on

their feet meeting every milestone on time. They still fit in to

normal cloths, cribs, high chairs and car seats with the FAB on their

feet, it becomes only a small extension of the child, for a small

part of their life.

>

> By the end of the treatment period, the feet have grown, the bones

have hardened as they do, and the correction is now maintained simply

by the natural growth and exercise of the foot. Because no bones

were cut, lengthened or shortened, no pins were surgically inserted,

no tendons were cut, no muscles were peeled back to expose the bones

for surgery - there is nothing to heal, nothing to infect, and

nothing to malfunction. The entire foot can now grow and function

completely normally for the rest of that individual's life.

>

> No surgical theaters. No anesthesia. No pain killers. No

antibiotics. No hospital stays. No IV's. No starving the infant for

hours prior to the operation. No separation of the infant from his

parents. Reduced cost of treatment. Ninety-five percent success

rate. The promise of normal, natural feet. No ugly scars on the

outside of the skin, or crippling scar tissue growing on the inside.

Fifty years of use and follow up studies to back it.

>

> And still, no one wants to listen.

>

> And still, as the parents of children born with clubfoot, as

citizens in the most medically advanced nation on this earth, we find

surgical treatment of clubfoot not only barbaric, but irresponsible,

negligent to the extent of malpractice...and completely unacceptable.

>

> Why then will no body listen?

> Because we're talking about feet? Because there is no drama

to a non-surgical method? Ask the parents of children born with

clubfoot if their child's birth defect lacks drama.

>

> According to the March of Dimes:

> Neural Tube Defects (NTDs) affect 1 per 2,000 births.

> Down Syndrome ranks at 1 in 800 births.

> Sickle Cell Anemia affects from 1 in 500 to 1 in 1000 depending on

racial factors.

> Cleft Palate affects 1 in 1000.

> And Clubfoot is calculated to affect 1 in 735 births annually in

the United States, with higher rates abroad.

> It can be estimated by 2002 population figures that Clubfoot

affects approximately 4,000 to 5,000 American newborn babies each

year. More than Neural Tube Defects. More than Down Syndrome.

More than Cleft Palate. More or the same as Sickle Cell Anemia

> Even the March of Dimes remains unaware as their website suggests

as many as 50% of the infants born with Clubfoot will require a

surgical correction; that's forty-five percent more surgeries than

necessary. The Ponseti Method averages a low 5 percent surgical rate.

>

> But these are feet we're talking about, right? Who wants to pay

any attention to feet when there are much more exciting and dramatic

(although less prevalent) birth defects to talk about?

>

> Why talk about a non-surgical medical procedure when there are much

more colorful, gruesome, theatrical surgeries to broadcast? Blood

sells, right? Images of oxygen masks, heart monitors, teams of

doctors in their frocks hunched over a patient who is cut wide open?

Or a condition with no known cure? That's good television. Sick

children with no cure in sight. Twisted feet torturously dissected

is good television. A non-surgical method created by a Spanish Civil

War Veteran in 1948 who still practices at the age of 91 years old -

is also good television because behind the producer who has the guts

to broadcast this are 4,000 more babies being born this year who are

at risk of having their feet cut up unnecessarily - and you could

save them.

> We are here to nominate Doctor Ignacio Ponseti for the Lifetime

Achievement Award because he has truly given his life to these

crippled babies. His entire adult life, rapidly approaching a

century old, has been dedicated to achieving not personal goals for

his own fame and fortune because if that were the case, he and his

method would be world famous by now! But to achieving a happy life

minus the pain of deformed feet for thousands of babies world wide.

Abraham Lincoln said it best, " I can't think if my feet hurt. " If

ever a time in history demanded our future generations have clear

minds to think with, it is now.

>

> If awarded, Dr. Ponseti's wish is characteristically unselfish.

When asked, his only wish was that he be able to contribute more than

he already has, that his work be continued after he is gone though

the veins of his foundation: The Clubfoot Clinic Fund.

>

> This foundation supports research of clubfoot so perhaps the one in

a thousand babies currently born in the US each year with this birth

defect can be diminished if not eliminated completely (scientists

believe they have recently isolated the gene that causes clubfoot);

it supports the continued development of better treatment options

such as better casting materials and better designs of the Foot

Abduction Brace; it helps pay for treatments that otherwise could not

be afforded by economically challenged parents; it sends supplies and

braces to the poor and under-developed countries around the world; it

supports bringing in doctors from both America and over seas to train

with Dr. Ponseti and his colleagues in Iowa so they may take the

method home and continue its use; it funds the development of

clubfoot clinics in 3rd world countries where the rate of clubfoot

per capita is much higher than it is here in the US.

>

> Granted his wish, the sky would be the limit. More doctors could

afford to train under Dr. Ponseti; an educated medical community

could identify and eliminate from practice those who are performing

the method falsely; teleconferencing technology could be put in place

so doctors world wide could consult with one another directly,

sharing video images, photos, x-rays, advice, help and ultimately,

success. Public awareness in the general population could be raised

so eventually no child will have to suffer the consequences of

treatment that became outdated three years after their great-

grandparents came home from WWII - because through public awareness,

those methods would become as happily obsolete as Art Mooney's 1948

top ten song.

>

> Additionally, although Dr. Ponseti did not request this, we would

like to organize a reunion of his patients, both those who have been

treated by his gentle hands in person, and those who were treated by

his method thanks to the few doctors who have taken the time to learn

it. We would like to publicly honor the man who gave our children

back their feet.

>

> We nominate Dr. Ponseti not as a small group of mothers who meet at

the coffee shop with too much time on our hands - but as hundreds, if

not thousands of mothers, and fathers, and grandparents, aunts and

uncles and children young and old who have experienced clubfoot first

hand, who have educated themselves, their friends and their

neighbors, who have continued for years now the daunting task of

speaking loudly that the world might finally listen and finally

eliminate the primitive treatments still in use today on our young

babies.

>

> We nominate Dr. Ponseti on behalf of the 45,000 (yes, forty-five

thousand) babies who will be born in the U.S. over the next ten

years who will suffer this birth defect.

>

> It's been close to sixty years. It's time this great American

story is told to the world. It is time the world knew medical

science has escaped the 1940's and moved in to the twenty-first

century.

>

> He was an immigrant escaping the Spanish Civil War arriving in

America the year we entered World War II. Now he is a 91 year old

doctor who still walks to work each day to treat his tiniest of

patients, because if not Dr. Ponseti, then who? The world must

learn and new young doctors must move in to fill the shoes, to

advance the method, to save the babies.

>

> We, the parents of children born with clubfoot implore you to

explore the rich and colorful life of this silent American icon so he

will not only get the recognition he deserves after half a century of

service, but also so no other baby will have to endure the horrors of

having their feet taken apart and put artificially back together

unnecessarily.

>

> If nothing else happens from our attempt to honor Dr. Ponseti with

the Lifetime Achievement Award, one very key thing has happened

right before your very eyes: you, the reader, are now informed.

>

> We the parents of children born with clubfoot have reached one more

person, who will, some day, tell two friends who will, someday, tell

two friends. And thus, the Ponseti Method has survived for half a

century one person at a time - and truly, that is probably the only

reward Dr. Ponseti would ever ask for, that the word be spread, even

if by only one mouth and one ear at a time. He doesn't want awards,

he wants to see an end to the senseless brutality our trusted doctors

are inflicting upon our tiniest of babies. Once that is

accomplished, then, maybe then, he will finally feel it is safe for

him to retire and pass his torch to the next generation trusting we

will keep it burning.

>

> Summary and Contact Information:

>

> There are two forms of clubfeet. The first is relatively minor

and known as Positional Clubfoot often due to a lack of amniotic

fluid in the uterus cramping the baby's development. The second is

Congenital Clubfeet, it is considered idiopathic, meaning doctors are

not entirely sure what causes it , but suspect it caused by an

unknown genetic factor coming in to play affecting the baby at

approximately 20 weeks post conception. There also appears to be a

slight inheritance factor involved as well, although not always.

Because clubfoot is not present in the early weeks of development

when most ultrasounds are performed, the condition is often not

discovered until the child's birth.

> The Ponseti Method of Clubfoot correction is superior to the

traditional method of treatment in that the baby's bones are gently

persuaded to move in to their natural position through a process of

systematic serial castings. No surgeries take place. No bones are

cut, broken, or pinned back together. No muscles or tendons are

stripped. No joints are penetrated. The method is completely non-

intrusive. Done correctly the foot is allowed to continue its

natural progression in to adulthood allowing these child to live

normal, active lives.

> With correction performed properly by a qualified physician and

with the parent's diligent and dedicated use of the FAB (Foot

Abduction Brace), babies treated by the Ponseti Method enjoy a 95%

success rate, i.e., 95% of the babies will never need a surgical

attempt at correction.

>

> For more information about the clubfoot deformity, please contact

the University of Iowa Clubfoot Clinic at (319)356-3469 or visit

http://www.vh.org/pediatric/patient/orthopaedics/clubfeet/index.html

for medical reports, articles, FAQ's, testimonials and photos.

Parents or family members of a clubfooted baby are urged to join the

nosurgery4clubfoot group at Yahoo! groups,

nosurgery4clubfoot for advice and support.

>

> This Nomination is sent to you by the Parents of Children Born With

Clubfoot and the children born with clubfoot who became the victims

of misinformed doctors, as well as the children who have most

blessedly been cured by the life's work of Dr. Ignacio Ponseti -

and all the clubfooted babies yet to come.

>

> Signed and Sincerely,

>

> ee and Chriss Reese of Oklahoma

> - parents of two clubfooted sons, who remains somewhat

crippled because we did not know yet about Dr. Ponseti, and Everett

who enjoys perfect feet thanks to Dr. Ponseti.

> Harvey and June Reese of Oklahoma

> - parents of one clubfooted child, Mark, who remains with crippled

feet because no one knew about the Ponseti Method.

> Leroy Reese of Oklahoma

> - father of one clubfooted son, Greg, who remains with crippled

feet because no one knew about the Ponseti Method.

>

> Others add your names like this too and grow the list

>

September 6, 2005

ee-

This was/is beautiful! Thanks for doing this-it is truly a labor of

love.

Please add our names to it!

Thanks Again,

Kathleen and Fulcher, parents to , born with

bilateral clubfeet, Ponseti method treatment and straight tootsies!!

> , and Everyone,

> here is the email version for the Life Time Achievement Award

Essay - (I'll send an attachment version also for easier printing

and/or editing if you choose). I hope this is somewhere with in a

hundred miles of what you were anticipating. I asked Joyce Roller

for more specifics but have not heard from her, so I went with what

I had and am sending it before you think I'm blowing off my

assignment here. Actually, ask my husband, I've lost a lot of

sleep, such a responsibility, such an important undertaking!

>

> If it sucks I'm not offended if you scratch it out and start from

scratch. Woven throughout you will notice I used your key points.

Likewise, if there is any mis-information that needs corrected by

all means bring it to my attention, or if anyone has information

prudent to the cause that I totally over looked, that too should be

brought forth! Because there was not a page limit / word limit, I

did not limit myself or even attempt to. It's double spaced and

justified for easier reading. Nor did I bring a case history of

any particular patient in to it, aiming to be objective and factual,

yet tell the story in such a way as to convey the man's compassion

and the legitimacy of this birth defect. I told it from the

standpoint of " We the parents of children born with clubfoot " ....I

do not mean to exclude those here who are now adults who were born

with clubfoot, but the objective is to spread the word that new born

babies will not endure the tortures of misinformed doctors using out

dated treatments.

>

> And with all that as my disclaimer, sitting here insecurely as I

toss out my wares for inspection, here is the actual essay as it

sits on my desk tonight.

> Blessings to all,

> ee

>

> Dr. Ignacio Ponseti Lifetime Achievement Award Essay

>

> by: ee Reese

> September 2005

>

> Five years after the Spanish military initiated an uprising

against their own Republican government sparking years of Civil War,

lin D. Roosevelt made his historic 3rd Inaugural Address to the

Nation, Pearl Harbor was obliterated, the famous Infamy Speech was

delivered, and the United States, having already suffered twelve

years of economic collapse on the heels of fighting World War I,

entered World War II.

>