This fascinating little book emphasizes the importance of a more temperate operative approach to the treatment of congenital clubfoot in children and stresses the importance of manipulation, stretching, and the use of casts. In the preface, the author states: "Our treatment, supported by limited operative interventions and based on a clear understanding of the functional anatomy of the foot, has yielded optimum results in a high percentage of patients." Certainly, the results are impressive, as shown by Cooper and Dietz in the article "Treatment of Idiopathic Clubfoot. A Thirty-Year Follow-up Note" (J. Bone and Joint Surg., 77-A: 1477—1489, Oct. 1995).
The book's eleven chapters, all of which are profusely illustrated, contain words of wisdom from a physician who has spent his entire career treating this complex deformity. There is a wealth of information in the descriptions of pathological anatomy in Chapter 2; of structural changes in muscles, tendons, and ligaments of the leg and the foot in Chapter 3; of functional anatomy in Chapter 4; and of pathogenesis in Chapter 5. Ponseti clearly describes the technique for the application of a cast that is used at his clinic. Each step of the procedure is explained relative to the anatomy and kinematics of the foot in a very logical fashion. Even though this is not a treatise on the operative treatment of clubfoot, the basic procedures that are required to achieve an optimum result are clearly explained and illustrated.
At a time when more radical operative treatment is being advocated for younger patients, this moderate approach is most welcome. Any pediatric orthopaedic surgeon who treats clubfoot should read this book repeatedly; indeed, it is written so eloquently that one never tires of reading it. Like the award-winning thesis by Brockman in the 1930's, this book should be a trendsetter for the treatment of clubfoot in the 1990's and beyond.
S. Jay Kumar, M.D.
Alfred I. duPont Institute
Wilmington, Delaware