The 1st South African Ponseti Seminar for Clubfoot Care was hosted by STEPS Charity in conjunction with Johannesburg Hospital's Paediatric Orthopaedic Ward. Karen Moss, mother of a son born with bilateral clubfoot treated by Dr Ponseti in 2003, started STEPS Charity in July 2005.

STEPS Charity provides support for South African babies and children with lower limb disorders. A primary goal is to spread awareness about Ponseti in South Africa where previously over 80% of children with congenital clubfoot were having PMR surgery.

The South African Ponseti Seminar had the endorsement of Dr Ignacio Ponseti and the Wits Medical School. Donald Gordon Medical Centre, an independent university hospital committed to advancing specialist training and research, provided their conference facility for lectures and practical sessions.

I congratulate you for your enormous efforts to organize the convention which I know was a great success. - I.V. Ponseti, 8 August 2006

THE DELEGATES

The intention for the 1st Ponseti Seminar was to obtain consensus from South African paediatric orthopaedic surgeons. We had good representation from all over South Africa and neighbouring country Lesotho, private and state practice, and orthopaedics professors from leading medical schools. We were pleased that some allied professionals like casting technicians and orthopaedic nurses attended. Total attendance of 56 delegates far exceeded expectations (and our original database) which shows the positive response to the Ponseti technique.

Surgeon/Professor/Registrar: 40
Orthopaedic Nurse/Casting Technician: 13
Physiotherapist: 2
Orthotist: 1

Geographic spread was most of South Africa's main centres, some smaller towns serving rural areas and the Kingdom of Lesotho: Johannesburg, Pretoria, Cape Town, Durban, East London, Bloemfontein, Mthatha (Umtata), Nelspruit, Empangeni, Welkom, Ladysmith, Lephalale (Naboomspruit), QwaQwa, Empangeni, Potchefstroom, Bethlehem, Mtunzini.

THE FACULTY AND PROGRAMME

International faculty:

The international speakers were fantastic, hard-working and committed to making the seminar a success. They brought a lot of demonstration models long-distance for use at the seminar.

Dr Shafique Pirani (Canada), Dr Naomi Davis (UK), Dr Monica Nogueira (Brazil)

Guest speaker: Prof Arnold Christianson (Human Geneticist, NHLS Wits University, South Africa)

Other speakers: Dr Mark Eltringham, Gavin Shnier (Orthotist), Karen Moss

Practical sessions

Day 1: 5 patients came for casting from the Johannesburg hospital, ages ranged from newborn to a few months old. The 3 international Ponseti doctors and Dr Mark Eltringham did the casting, assisted by a volunteer delegate as the others watched. There was a follow-up practical casting session for all delegates to practice the technique on the Mitchell rubber legs.

Day 2: Parents brought in treated patients at different ages and stages, an infant in fulltime FAB wear, a 2 year old in night-time FAB wear, a 3.5 year old out of FAB wear, a relapse after PMR surgery and a newborn with a Trisomy syndrome who had casts applied. There was a general discussion about the results and long-term expectations.

Talks

Full programme of talks is available for download at www.steps.org.za/ponseti-seminar. Top 10 talks/sessions according to the 45 evaluation forms received.

RESULTS AND RESPONSE

We had an overwhelming positive response from all delegates. Many expressed their gratitude for the seminar, and asked to have follow-up with frequent specialised sessions so more allied professionals could learn the plaster technique and how to make the low-cost Steenbeek Ponseti FAB designed in Uganda.

Of the 45 evaluation forms handed in:
98% said the Ponseti Seminar would change the way they run their practice
96% said they would attend another Ponseti Seminar

There was a strong interest in Dr Pirani and Dr Nogueira's experiences in Uganda and Brazil as being similar to South Africa where many of the same conditions exist.

Delegate feedback:

• Excellent seminar bringing a revolutionary corrective method that has immense benefits for care of children's clubfoot deformity. Thanks for organising"
  
• Very good initiative, "eye-opener" for a congenital foot problem with high incidence in South Africa, very encouraging worldwide results"
  
• I gained a lot from the Ponseti method and I would like to implement it in my institution"
  
• Very very exciting, I am very appreciative"
  
• Please hold these sessions on regular basis for training"
  
• I never knew about the Ponseti Technique and I feel very guilty about those I have treated with the wrong technique. I have hope that the future for those with clubfoot is in good hands"
  
• Very informative seminar and hope it can be made more accessible to the whole of South Africa community. Wow!"
  
• Please don't forget the rural, poor areas of South Africa! We need your support in terms of braces and supervision"
  
• Very good seminar, impressed with the technique. I'm planning to start the practice in my area. Thank you."
  
• It was the most interesting seminar I have ever attended, keep serving the community"
  
• Excellent - menu accommodated people of all colour"
  
• We are definitely going to change the way we work at the clinic"
  
• Wish to have the same implementation of Ponseti method as it is done in Uganda and Brazil."
  
• Thank you for the excellent idea of expanding this method to the rest of South Africa's orthopaedic surgeons."
  
• Dr Pirani is a great inspiration!"
  
• Very informative and encouraging"
  
• I learned a lot. People were very warm."
  
• A wonderful team. Fabulous visitors from outside South Africa"
  
• Thank you and congratulations to Karen Moss and to all the presenters"
  
• Excellent and timely seminar. The faculty are all excellent"
  
• We would like this type of seminar to be conducted frequently all over South Africa and try to involve every health discipline, i.e. doctors, nurses, physiotherapists, orthotists, occupational therapists, etc."
  
• I enjoyed it very much. Thanks to speakers and visitors"
  
• Very enjoyable course."
  

FOLLOW UP & FUTURE PLANS

There is an immediate need for specialised workshops for plaster casting and FAB manufacture which is an intrinsic part for the success of the technique:

• Training of prosthetists and technicians at state hospital / clinic orthopaedic workshops in manufacture of cost-effective Steenbeek FAB for patients without medical insurance.
• Ongoing follow-up training of allied professionals; nurses, physiotherapists and casting technicians.

The South African Ponseti seminar will be an annual event. The 2007 seminar will include more practical workshops for all allied health professionals, and the Department of Health with a strong focus on rural areas and primary health care. The next seminar will include more delegates from other African and other countries.

We will work with the Department of Health to develop a programme similar to the Uganda Clubfoot Project so that the Ponseti technique is standard national guideline for clubfoot treatment. The project at primary health care levels will necessitate training of nursing staff in preliminary diagnosis, parent counselling and support. STEPS will be involved in writing a clubfoot care guide for nurses and for parents.

Angola is interested in holding training sessions for their doctors. Mozambique needs a training programme. Future Ponseti seminars would incorporate programmes for these countries by Portuguese-speaking doctors.

OUR SUPPORTERS

We are most grateful to our sponsors who helped to make the seminar possible: SAVRALA, South African Airways, BSN Medical, Absa Bank, Wits Donald Gordon Medical Centre, City Lodge, Pfizer, MMPA, Adcock Ingram, Avis Point to Point, Naomi Davis (Both Feet Forward), Missing Link, Hightide Print.

Special thanks to Eventfull Productions, the event organisers (Elaine and Kim). And to MMPA who provided audiovisual equipment and technical support.

Karen Moss, CEO STEPS Charity
16 August 2006