I knew little about the condition, so I was surprised to discover how prevalent it is; at the moment it is estimated 1 in every 750-1000 children born is affected. Fortunately its treatment by the Ponseti method is now well understood, simple and inexpensive.
What is the Ponseti method?
The Ponseti method involves gentle manipulation of the tendons and ligaments followed by a series of 3 to 5 casts to restore the feet into the correct position.
This is usually followed by a minor surgical intervention to release the Achilles tendon under local anaesthetic. Full correction is usually achieved within 6 to 8 weeks and is best completed as soon after birth as possible.
At this point the feet are fully corrected and the child can function normally. However, the child must wear a foot abduction brace (which holds the feet at 65 degrees) at night for 4 to 5 years to lower the risk of relapse.
Practically any child born with this condition in a developed country will be treated and live full and normal lives. However, in developing countries it is another story – it goes largely untreated, leaving a child with years of disability and stigma, and has a significant impact on their ability to contribute to society.
There is a medical device, usually referred to as ‘boots and bars’, that performs the Ponseti method of gradual restoring of the feet to the correct position. It is a simple device compared to the complex mechanisms that we are used to designing at Team, but it struck me that it must be one of the most complicated devices for usability and compliance.
For four long years you have to persuade a wriggly baby – and then an energetic toddler – to wear a constraining and, I imagine, annoying device with no immediate benefit, and all the time they feel and look totally healthy. And the results of not wearing it can be dramatic.
Even with ongoing medical support and check-ups, compliance is hard in developed countries; but it can be even harder in developing countries. As well as the inconvenience, there is also the cost. A set of ‘boot and bars’ can cost hundreds of pounds, and it needs updating as the child grows – which is fine when it is covered by the NHS or health insurance, but is a huge barrier where these are not available.
In order to support its programme of clinics around the world, MiracleFeet has developed its own brace. It costs only $20 and is as effective as the more expensive versions. Once the boots are on the feet, the shoes can then be attached to the bar, crucially helping with usability.
While it is not as technically complex as some of the products we get involved with at Team, I was envious of those involved, like my friend who is their Executive Director, who had the opportunity to wrestle with the complex issues involved in developing such an important and life-changing device.