The Case of the Prolific Poet with a Crooked Foot

Albert B. Lowenfels, MD; Shevaun Mackie Doyle, MD

Disclosures

August 22, 2008

How Would Byron Be Treated Today?

Early detection and treatment of CTE are essential to prevent gait abnormalities, foot pain, and callosities in the older ambulatory child. Ignacio V. Ponseti, MD (Figure 3), from the University of Iowa, can be credited with the development of a comprehensive technique for treating congenital CTE in the 1940s. The major principle of Ponseti's technique is that the contracted tissues of the newborn's foot will yield to gentle manipulation and casting of the feet at weekly intervals. The technique enables successful correction of the deformity without the need for major reconstructive surgery.[8,9]

Figure 3.

Ignacio V. Ponseti, MD, founder of the modern treatment for clubfoot. He has practiced at the University of Iowa for more than 60 years. With permission from the University of Iowa Foundation.

The Ponseti technique has revolutionized the way that clubfeet are treated throughout the world. The technique is divided into a treatment phase and maintenance phase. The treatment phase, initiated within the first week of birth, consists of gentle manipulation and plaster casting. This is performed weekly until the foot is properly aligned. Usually 5 casts are required to achieve correction. At the final casting visit, in most cases, the infant will need to have the Achilles tendon cut through a skin puncture. This office-based minor procedure allows full correction of equinus deformity of the heel. The maintenance phase starts when this final cast is applied and worn for 3 weeks. Following the cast, the infant is placed into a removable orthotic device that consists of special orthopaedic shoes attached to a bar. Initially, the orthotic is worn for 23 hours per day for 3 months and then just during sleep until age 4.[9] If the parents are compliant in following the nonoperative treatment protocol, a successful result can be achieved in about 90% of patients.

Should the infant have a recurrence and recasting fails, or if initial cast treatment fails, then surgical release of the CTE is performed. This is achieved through a large incision in the back of the ankle, just above the heel. The surgical correction involves extensive, meticulous dissection and reconstruction of tendons, ligaments, and bones.

Other Famous Individuals Who Have Suffered From CTE

Claudius I -- Ruler of the Roman empire from 41 AD until 54 AD

Josef Goebbels -- Hitler's notorious propaganda minister in World War II. His CTE made him ineligible for active military service.

Kristi Yamaguchi -- A 1992 Olympic gold medal winner in figure skating and a member of the US Olympic Hall of Fame. In May 2008 she became the champion of the televised competition Dancing With the Stars.

Benoit Huot -- A Canadian gold-medal Paralympic swimmer who is expected to participate in the Beijing Paralympics

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