In the beginning was the deformity…As the pioneers of the functional method of conservativetreatment of talipes equinovarus, we are pleased to be giventhis opportunity to describe the beginnings of this methodfor the historical archives of paediatric orthopaedics.The Bretonneau University Children’s Hospital (BUCH)in Paris was known as a place where physical therapy hadbeen traditionally used for the benefit of sick or disabledchildren, especially for those with problems stemmingfrom orthopaedic abnormalities. In 1950s, physical therapyreceived global recognition for its value as part of theconservative treatment of spinal deformities and of cerebralpalsy. As defined by Prof. G. Laurence, Head of theDepartment of Pediatric Surgery and Orthopaedics, and Dr.P. Masse, the Assistant in Orthopaedics of BUCH, the roleof physical therapy in the treatment of foot deformities wasfocused in the setting of clubfoot and it was aimed towardsgreater flexibility of the foot in order to lessen the difficultyand extent of surgery. Together with the chief of physicaltherapy, Dr. Masse stated that the physical therapy aspectwas supplementary to surgery, and that its function waslimited to preparing the foot to the knife: ‘‘….With veryrare exceptions, however, we cannot claim that we are ableto correct a clubfoot only with orthopaedic treatment,whatever the approach and in spite of the availability ofstate-of-the art technology’’ [1].The BUCH protocol consisted of vigorous stretches incombination with the application of rigid tape for fixing thefoot to a Dennys–Browne splint. Due to the forcefulpressure induced by the stretches, the manipulationsthemselves were often harmful. The babies characteristi-cally cried throughout the whole physical therapy session.Moreover, children were obliged to wear orthopaedic shoesfor years and had to use rigid shoeing-splints during thenight. Practicing sports was severely restricted. This con-servative treatment approach was capable of correcting themild form of clubfoot deformities (grade A), but it couldnot prevent the need for more extensive surgery in thehigher grades. Moreover, there were frequent recurrences,even in idiopathic clubfeet.This technique was used for years, until H. Bensahelbecame Head of the Department of Orthopaedics at BUCH.He was adamantly against it and succeeded in convincingthe new physical therapy chief and her team of the supe-riority of an alternative modality, whereupon that approachfor the treatment of clubfoot was abandoned altogether. Hisnovel pathophysiologic concept of clubfoot and, moreimportantly, a new philosophy of its treatment was adop-ted, and the functional method of conservative treatmentwas launched. A revolutionary philosophy based onrelaxation replaced the stretching one that was associatedwith infliction of pain and the child’s tears. The newlyconceived pathophysiology focused on the origins of thedeformity at the level of the Chopart-midtarsal joint [2].The functional method was developed and implementedduring the early 1970s. It is also used at the Robert DebreChildren’s University Hospital (Paris) which replacedBUCH. Years of experience have led to the refinement ofseveral technical aspects and to the improvement of itsefficiency and effectiveness [3–4]. A yearly training course
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Oct 25, 2023
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