title: Management of idiopathic clubfoot after formal training in the Ponseti method: a multi-year, international survey.
abstract: BACKGROUND
  Over the past decade, the Ponseti method has become the standard of care to treat clubfoot amongst orthopaedic surgeons around the world. Since 2001, the University of Iowa, under the guidance of the late Dr. Ignacio Ponseti, has been teaching the Ponseti method through a standardized training course. This study examines the current clubfoot management practices of those who have participated in the course and the effectiveness of formal Ponseti Training Courses.
  
  
  METHODS
  An online survey was administered to practitioners who participated in the University of Iowa Ponseti Training Course from 2001-2011.
  
  
  RESULTS
  One hundred and thirty-one practitioners responded to the survey representing 33 different countries and 70 different orthopaedic societies. Ninety-seven percent of practitioners reported currently using the Ponseti method as the preferred treatment for clubfoot. The respondents reported the average duration of each cast was 9.21 days (SD=9.04 d) and the average cast phase of treatment lasted 7.62 weeks (SD=2.43 w). Physicians were responsible for applying the cast 79% of the time. Braces were utilized following casting by 96% of physicians. The average age of brace use was 41 months (SD=16 m). The reported relapse rate was 21% (SD=17%). Ninety-seven percent of practitioners changed their practice after completion of the course. The preferred method prior to the course was surgical release (48%). Sixty-one percent of practitioners preferred review articles as an additional educational support; 49% preferred training videos. Sixty-seven percent believed an 'on-site' visit to their hospital by an expert in the Ponseti method would be very beneficial. Seventy-three percent suggested improving the course by providing more 'hands on' experience. Ninety-five percent of practitioners were satisfied with the course.
  
  
  CONCLUSIONS
  The Ponseti Training Course is an effective way to educate physicians on how to treat clubfoot with the Ponseti method. However, improvements should include more hands-on learning as well as an 'on-site' visit with an expert Ponseti practitioner.
authors.affiliation: Department of Orthopaedics and Rehabilitation Carver College of Medicine University of Iowa.
authors.forename: Jayawardena
authors.initials: J
authors.lastname: Asitha
authors.forename: Lewis E
authors.initials: LE
authors.lastname: Zionts
authors.forename: Jose A
authors.initials: JA
authors.lastname: Morcuende
mesh_terms: D001915:Braces; D002370:Casts, Surgical; D003025:Clubfoot / Q000601:surgery / Q000628:therapy*; D019538:Health Care Surveys; D006801:Humans; D008349:Manipulation, Orthopedic / Q000379:methods*; D019637:Orthopedic Procedures / Q000193:education*; D010820:Physicians; D016896:Treatment Outcome
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