Ignacio V. Ponseti, MD 1914-2009

Journal of Bone & Joint Surgery - American Volume:
doi: 10.2106/JBJS.I.01570
Obituary

    Ignacio Ponseti Vives was born on the island of Minorca on June 3, 1914. He was admitted to the University of Barcelona on a scholarship. There he acquired a strong focus on biology, which led to his many contributions to the pathology of skeletal growth disorders and to the understanding of the pathobiology and mechanics of clubfoot deformity.

    His passion for music, art, and nature developed as a student in Barcelona, where he met many great personalities destined to bring about a major revolution in the arts throughout the world. Pablo Casals and other prominent musicians gave concerts. Picasso and Miró were among the many painters and sculptors exhibiting their works in Barcelona. Authors such as Garcia Lorca presented their works to enthusiastic audiences, and among them was Ignacio Ponseti, the university student. During his time as a student, his love of nature and the mountains also developed through his weekend hikes in the Pyrenees as a member of the Catalonia Hiking Club.

    He finished his final examinations one day before the Spanish Civil War began, July 17, 1936. Within days he was at the front in Aragón, treating war wounds based on the tenets of Nebraska orthopaedic surgeon H. Winnet Orr, which were modified by Joseph Trueta, a fellow Catalan, during this conflict. As the war ended, he helped evacuate wounded Loyalist Army soldiers across the Pyrenees into France. Mexican President Cárdenas offered the thousands of Spanish refugees, now without nationality, citizenship.

    In late 1939, Ponseti arrived in Mexico City. Unable to find work, he moved to Juchitepec, a town of 5000 inhabitants where he worked as the town doctor, often traveling many miles on horseback to tend to needy patients. On his monthly visits to Mexico City, he discussed medical schools in the United States with Dr. Juan Farill, the respected head of the Children’s Hospital. Farill had studied under Dr. Arthur Steindler at the University of Iowa on a Guggenheim Fellowship. Farill wrote to Steindler, recommending Ponseti for a one-year fellowship. On June 1, 1941, at twenty-seven years of age, Ignacio V. Ponseti arrived in Iowa City, Iowa.

    After finishing the one-year fellowship, he was given a resident position in the Department of Orthopaedic Surgery. In 1944, Steindler invited him to join the Iowa faculty. In his early years, he spent much of his free time teaching pathology to the residents and studying bone pathology in the extensive departmental collection that had been started by Ernst Freund and continued by Vernon Luck. He also developed an interest in the natural history of congenital and developmental skeletal disorders. In the 1950s, he developed one of the first connective tissue biology and biochemistry laboratories in the country, with the goal of discovering the causes of skeletal deformities, including scoliosis and skeletal dysplasias. He led pioneering studies on the effect of aminonitriles on collagen cross-linking, which laid the foundation for the early understanding of collagen biochemistry and matrix biology. For this work, he received the Kappa Delta Award from the American Academy of Orthopaedic Surgeons in 1955. He was one of the first to describe the pathologic lesions associated with Legg-Calvé-Perthes disease and the biochemistry of the normal physeal plate and the iliac apophyseal cartilage. He also described the biochemistry, histology, histochemistry, and ultrastructure of the growth plate in patients with multiple skeletal dysplasias. His studies of normal acetabular growth and developmental hip dysplasia greatly enhanced the understanding of this complex disorder. He defined the curvature patterns that can be seen in patients with idiopathic scoliosis and was one of the first to demonstrate that curves could progress after maturity.

    He served as Assistant Editor for The Journal of Bone and Joint Surgery (American Volume), an examiner for the American Board of Orthopaedic Surgery, and President of the Orthopaedic Research Society. He was awarded the Ketoen Gold Medal from the American Medical Association in 1960, and, in 1975, he was selected as the Alfred R. Shands Jr., Lecturer by the American Academy of Orthopaedic Surgeons. In 1984, he was awarded an honorary doctoral degree from the University of Barcelona.

    In 1984, at seventy years of age, he “retired” from the University of Iowa. This retirement was fortunately short lived. In 1986, he began anew his quest to educate doctors and patients about a way to treat the crippling disorder of clubfoot without surgery. In the late 1940s, he had reviewed the results obtained in Steindler’s patients, who had had surgery to correct a clubfoot deformity. These patients had stiff, painful feet; he knew there must be a better way. Physicians had been manipulating clubfeet since the time of Hippocrates; but his studies of the pathoanatomy of the deformity and understanding of the movement of foot bones and joints, particularly the subtalar joint, led to the development of what came to be known as the Ponseti Method. The method involved precise manipulations followed by the application of holding casts that were changed every three to five days, resulting in successful correction of the deformity after three to five cast changes in most cases.

    Despite twenty and thirty-year follow-ups of clubfoot treatment with use of the Ponseti Method and despite the 1996 publication of his book, Congenital Clubfoot: Fundamentals of Treatment (Oxford University Press, 1996), physicians continued to use surgery as the primary treatment for clubfoot. The advent of the Internet and creation of a web site developed by a parent of a child successfully treated with use of the method were the stimulus for change. Physicians from around the world began coming to Iowa City to learn the technique from Dr. Ponseti. An international symposium on clubfoot, held in 2006, showed 95% successful results with use of the Ponseti Method in centers around the world, including centers in developing nations with limited physician resources. In 2006, the American Academy of Pediatrics endorsed the Ponseti Method. In that same year, the State Board of Regents of the University of Iowa established the Ponseti International Association, which was dedicated to “improving the treatment of children born with clubfoot through education, research, and improved access to care.” In 2007, Dr. Ponseti was recognized by the University of Iowa with an Honorary Doctor of Humane Letters.

    He was respected and admired by the thousands of students and hundreds of residents and fellows trained by him during his sixty-five-year career. He was beloved by his patients and their families. His legacy to all was his humanity, his strong sense of medical ethics and its application to the decisions made in caring for patients, his eternal quest for the fundamental understanding of disease, and his tireless curiosity. He was a constant inspiration to his colleagues; a role model for his students, residents, and fellows; and a source of comfort for his patients.

    He continued seeing and treating patients with clubfoot and educating doctors from around the world until the time of his death. He died the day following the annual Ponseti Clubfoot Symposium and a fundraising Ponseti “fun run” by his former clubfoot patients.

    He is survived by his wife of forty-eight years, Helena Percas-Ponseti, a world authority on Cervantes, who shared his love of music, art, literature, and nature; and by his son, Bill, of Novato, California.

    S.L.W.

    Copyright 2010 by The Journal of Bone and Joint Surgery, Incorporated