Clubfoot deformity occurs in one out of every 750 births in every country around the world, often leading to lifelong disability. The nonsurgical, low-cost, low-tech, highly effective Ponseti method for correcting clubfoot can be administered everywhere. Learn how you can raise awareness, advocate for better access to treatment, and provide financial and logistical support for treatment in your community.

1. 2016 ROTARY INTERNATIONAL CONVENTION
HOW ROTARIANS CAN HELP END
DISABILITY FROM CLUBFOOT

2. Presenters:
Jim Coloff, DGE 5970
Chris Knapp, DGE 6000
Herb Wilson, PDG 6000
Tomeka Petersen, RAG4Clubfoot Program Development Administrator,
Program Coordinator for Ponseti International Association and
Member of Rotary Club of West Liberty, Iowa
May 30, 2016

3. What is Clubfoot?
Congenital
Talipes
Equino-
Varus
1324 BC

4. What causes Clubfoot?
Muscle & tendon
imbalance in the lower leg
leading to skeletal
deformity in the foot-ankle.
NOT due to:
Fetal positioning
Lunar eclipse
Ancestral curse
Birth control pills
Poor nutrition
Polio
Witchcraft
Twin births, etc.

5. • Approximately 1 in every 750 live births
• Twice as common in males as in females
• Occurs in both feet half of the time
• A very slight correlation of family history and ethnicity
• 200,000 children born with clubfoot annually
• 100,000’s of “neglected” cases (~1 Million)
• No social or economic influences
Who is affected?

6. Countries Needing Training of Ponseti Method Providers
Visit RAG4Clubfoot
HoF Exhibit #3138
for details

7. Why be concerned?

8. • An 8-year-old Nigerian boy
with primary neglected
clubfoot.
• Abandoned to live with his
grandmother.
• Discovered crawling around in
a rural village by medical
students on an outreach visit.
Ray*
*Name changed

9. What does not fix Clubfoot?
Taping
Thomas Wrench
Solar Eclipse
Surgery
Swathering
Herbs &
Potients

10. The Ponseti Method Treatment of Clubfoot
The PONSETI METHOD
• Gentle manipulation and stretching
• Series of precisely applied plaster casts
• Percutaneous tenotomy (most cases)
• Wear brace while sleeping to age fourIgnacio V. Ponseti
(1914-2009)
Endorsed and
supported by

11. Dr. Ignacio V. Ponseti (1914 – 2009)
• Born in Menorca, Spain.
• Graduate of Barcelona University Medical
School.
• He fled Spain during the Spanish Civil War
(late 1930’s), then moved to Mexico where for
two years he practiced family medicine.
• A physician in Mexico helped Ponseti get to
Iowa in 1941 to study orthopaedics under
Arthur Steindler, M.D. Ponseti completed a
residency at Iowa in 1944 and became a
member of the orthopaedic faculty at UIHC.
Ignacio V. Ponseti
(1914-2009)

12. Early Research Leads to Ponseti Method
• In the early 1940s, Dr. Ponseti’s research
showed that surgery, the most common
treatment of clubfoot, could leave a child
with stiff ankles and a limp.
• Ponseti Method involves “gentle
manipulations” by slowly and gradually
straightening and rotating each twisted
foot toward its normal position.

13. Parents Request Ponseti Method
• Ponseti Method became popular in
the 1990’s when parents began to
spread the word through the
Internet.
• Orthopedists found parents
requesting them to perform Ponseti
Method to treat children.

14. Ponseti Method video

15. What is the Global Challenge?

16. The Global Challenge is
That thousands
of children born
with clubfoot
lack access to
well trained
Ponseti Method
providers.

17. Logistical Challenges
Due to logistical obstacles, too many children drop out
of treatment
• Cost of casting materials
• Cost of the brace to maintain the correction
• Cost of meals
• Cost of lodging
• Distance to get to appointments
• Cost for transportation to get to appointments
We must overcome these
challenges to prevent
return of the deformity.

18. Bracing Is a Global Problem
Especially in low-resource countries
Bracing is critical for maintaining the correction.
• Costs of current “state-of-the-art” clubfoot braces range from
$500 per year to more than $2,500.
• These braces are used almost exclusively in higher-income
countries.
• In low-resource countries, most braces:
 Are made using low-quality, locally available materials.
 Lack important design features.
 Often cause skin problems and disuse, resulting in
return of the deformity.

19. Rotarians Take Action

20. Discussions initiated in 2007 and then restarted in March 2014
Visit with C.K. Gary Huang
President, 2014-15

21. RAG4Clubfoot Approved in 2015
Rotarians in Iowa teamed up
with Ponseti International
Association (PIA) based at the
University of Iowa to create a
Rotarian Action Group,
RAG4Clubfoot.
We are proud of our logo!
Charter districts: 5970, 6000,
5020, 5240, 5950 and 9640.

22. RAG4Clubfoot Partners with
Ponseti International Association

23. Ponseti International Association (PIA)
PIA’s VISION: Every child in every country
will receive effective treatment for clubfoot
using the Ponseti Method.
• Established in 2006
• 500+ healthcare professionals
• hundreds of advocates
• 75 countries
PIA’s ACTIVITIES:
• Media - World Clubfoot Day
• Interact with professional societies
• Best Practice Guidelines
• International Clubfoot Registry
• Global web-conferencing
• International symposia
• Organize training activities
• Advice & assistance about
capacity building

24. Memorandum of Understanding signed between RAG4Clubfoot and Ponseti International (PIA)
Ponseti International Association’s role:
• To lead the educational components of the
Ponseti Method training of orthopaedic
surgeons.
• To identify in-country trainers who facilitate
the Ponseti Method training.
• To provide clinical expertise.

25. Ponseti International (PIA) to Lead Countrywide and Multinational Training Programs
Introductory Course – scientific basis
of clubfoot and the fundamentals of
clubfoot management.
Mentorship - mentoring by an
experienced provider for one week.
Visiting Professorship - continued on-site
mentoring by an experienced provider. Distance Education – consult, share
new information, and refine skills.

26. Building National Programs
A Short Course is
Only an Introduction
One-on-One Mentoring
Is Required to Learn the
Ponseti Method Correctly

27. What is a Rotarian Action Group (RAG)?

28. A Rotarian Action Group (RAG) is
• An association of Rotarians who provide assistance
and support to Rotary clubs, districts, and multi-
districts in planning and implementing large-scale,
community development and humanitarian service
projects.
• Approved by RI but
functions
independently from
RI.
26 current Rotarian Action Groups

29. What is RAG4Clubfoot?

30. RAG4Clubfoot serves as a clearinghouse to:
• Promote contact between local
Rotary clubs and qualified local
Ponseti Method providers.
• Promote collaboration between local
Rotary clubs/districts to fund clubfoot
treatment related projects
• Vocational Training Teams
(VTT) to increase the number of
qualified Ponseti Method
treatment providers.
• Humanitarian grants addressing
housing, meals, transportation
and bracing.
• Assist with public awareness
• Social media, brochures, public
service announcements on radio
and television, etc.
• Collaborate with government
officials and health
administrators with information
about the long-term benefits of
Ponseti Method treatment.
• Maintain a website
(RAG4Clubfoot.org) of approved
and developing clubfoot projects.

31. RAG4Clubfoot Organizational Graphic

32. RAG4Clubfoot Connecting Rotarians
Vocational Training Team grants submitted to RI for review
• Brazil (funded by Brazil District 4420 and USA Districts 5300, 5970 & 6000)
• Mexico (funded by USA Districts 5970, 6000 and 6960 and clubs in USA & Mexico)
To train 50 ortho surgeons in Brazil. To train 29 ortho surgeons in Mexico.

33. Ponseti Method Training Projects in Development
International Rotarians are communicating
with local Rotarians in:
• Argentina and Paraguay
• Bolivia
• Colombia
• South Africa
RAG4Clubfoot Board
members present at:
• District conferences
• Club meetings

34. Call to Action

35. How Rotarians and Others Can Help
Partner with international clubs/districts to:
• Create public awareness that “Clubfoot is treatable.”
• Promote identification & referral of patients.
• Support training of local orthopaedic surgeons.
• Assist with provision of high-quality braces.
• Assist with logistical support: meals, housing, and transportation.
Join RAG4Clubfoot
RAG4Clubfoot.org

36. Join RAG4Clubfoot

37. RAG4Clubfoot Membership
How do we join?
• Is open to active Rotarians, family members, program
participants and alumni.
• Individual membership is $25 / year.
• Charter membership is $100 the first year, $25 / year renewal.
Become a Member!
www.RAG4Clubfoot.org
Membership fees help support the
operational costs of the RAG.

38. Ray’s Ponseti Method Treatment Journey
Treated with
Ponseti Method
using five casts.
His mother brings
him to clinic on
the day his last
cast was removed.
Now walks independently
and is enrolled in school for
the first time.

39. Boy in Brazil pre and post Ponseti Method Treatment

40. WHAT WILL YOU DO TO HELP
CHILDREN LIKE RAY WALK?

41. THANK YOU.
RAG4Clubfoot.org
Email: info@RAG4Clubfoot.org
Visit HoF RAG4Clubfoot exhibit #3138

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