1

...1
...2
....3
...4

6
8
.10
.....12

() .14
...15
.18
..19

..20

Pirani..22
..23

..24

.26
..27
.....28
...29
Global-HELP
30
..31

,
.

, ,
,
, .
,
.
,
,

, . , ,
.
. 2003 4 , 10
. 50
.
,
,
. .
.

.
Global-HELP ( HELP), , , , , global-help.org.
:
.

,
-

.
, 2005

,
,

.


. , GlobalHELP , .

-
GeorgeMason

. 10 , .
2004
Global-HELP.

Global-HELP Organization

Copyright, Global-HELP Organization, 2003


. ,
, , .

.

Alaa Azmi Ahmad

Gaza city, Palestine
alaaahmad@hotmail.com

Jack Cheng
Hong Kong, China
jackcheng@cuhk.edu.hk
Christian and Brian Trower
trower@myrealbox.com

Franck Launay
Marseille, France
franck.launay@mail.ap-hm.fr

Marc Sinclair
Hamberg, Germany
sinclair@akkev.net

Dhiren Ganjwala
Ahmedabad, Gujarat, India
ganjwala@icenet.net

Natsuo Yasui
Tokushima Japan
nyasui@clin.med.tokushima-u.ac.jp

Monica Paschoal Nogueira

Sao Paulo, Brazil
monipn@uol.com.br

Max Vavilov
Timur Torno
Yaroslavl, Russia
http://www.rfasyar.ru/

Jose Morcuende
Iowa City, Iowa, USA
jose-morcuende@uiowa.edu.

Bertil Romanus
Goteborg, Sweden
bromanus@yahoo.com

Selim Yalcin
Istanbul, Turkey
selimyalcin@ultrav.net.

, .
.
50
.
.


.
A. , ,
, ,

.
, .
.

(m. tibialis anterior),
.
, .
,
.
.
, .


.
, .
. ,

.
, .
,

. .

.
, .
.
.
. .
.
, .
.
.

.

. ,
,
,
.

100

.


.

,
,
.

.
-
.

, .

.
,
.
, .
2
, .
35-

.
, .
.
,
.

.
- .

40- 22 , 20- , . , .

50- - , ,

- . , . , , .

, .

,
, ,
, . ,
-, -
. , ,
, .
,
, . "
",
1961 (), .



19361939 .,
2000 ,
, .

, .
()
, ,
. , . 1960-
" ". , , , ,
.. . , ,


.
,
, , , , ..
.

, , , , 12 20
3-5 . . ( ""
: , ).
.
,
: 75 () 20 ( ) .

5
3-4 , , ,
, .
14 16 ( ) 3-4
. .

,
, The Journal of Bone & Joint Surgery ("
") 1963 , . , , .
(metatarsal adductus), 1966 ,
, , . , .
-
1995 ,

,
. ,
. ,

, ,
, ,
.
, , . .
.
,
.
. , 2003

1963 Ponseti IV, Smoley EN. Congenital Clubfoot: The Results
of Treatment. Journal of Bone & Joint Surgery 45A(2):2261
2270.
1966 Ponseti IV, Becker JR. Congenital Metatarsus Adductus:
The Results of Treatment. Journal of Bone & Joint Surgery
43A(4):702711.
1972 Campos J, Ponseti IV. Observations on Pathogenesis and
Treatment of Congenital Clubfoot. Clinical Orthopaedics and
Related Research 84:5060.
1974 Ionasescu V, Maynard JA, Ponseti IV, Zellweger H. The
Role of Collagen in the Pathogenesis of Idiopathic Clubfoot: Biochemical and Electron Microscopic Correlations. Helvetica Paediatrica Acta 29(4):305314.
1980 Ippolito E, Ponseti IV. Congenital Clubfoot in the Human
Fetus: A Histological Study. Journal of Bone & Joint Surgery
62A(1):822.
1980 Laaveg SJ, Ponseti IV. Long-term Results of Treatment of
Congenital Clubfoot. Journal of Bone & Joint Surgery
62A(1):2331.
1981 Brand RA, Laaveg SJ, Crowninshield RD, Ponseti IV. The
Center of Pressure Path in Treated Clubfoot. Clinical Orthopaedics and Related Research 160:4347.
1981 Ponseti IV, El-Khoury GY, Ippolito E, Weinstein SL. A Radiographic Study of Skeletal Deformities in Treated Clubfoot.
Clinical Orthopaedics and Related Research 160:3042.
1992 Ponseti IV. Treatment of Congenital Clubfoot. [Review, 72
refs] Journal of Bone & Joint Surgery 74A(3):448454.
1994 Ponseti IV. The Treatment of Congenital Clubfoot. [Editorial] Journal of Orthopaedic & Sports Physical Therapy 20(1):1.
1994 Farsetti P, Weinstein SL, Ponseti IV. The Long-term Functional and Radiographic Outcomes of Untreated and NonOperatively Treated Metatarsus Adductus. Journal of Bone &
Joint Surgery 76(2):257265.
1995 Cooper DM, Dietz FR. Treatment of Idiopathic Clubfoot: A
Thirty-Year Follow-up Note. Journal of Bone & Joint Surgery
77(10):14771489.
1996 Ponseti IV. Congenital Clubfoot: Fundamentals of Treatment. Oxford University Press.
1997 Ponseti IV. Common Errors in the Treatment of Congenital
Clubfoot. International Orthopaedics 21(2):137141.
1998 Ponseti IV. Correction of the Talar Neck Angle in Congenital Clubfoot with Sequential Manipulation and Casting. Iowa Orthopaedic Journal 18:7470.
2000 Ponseti IV. Clubfoot Management. [Editorial] Journal of
Pediatric Orthpedics 20(6):699700.
2001 Pirani S, Zeznik L, Hodges D. Magnetic Resonance Imaging Study of the Congenital Clubfoot Treated with the Ponseti
Method. Journal of Pediatric Orthpedics 21(6):719726.
2003 Ippolito E, Farsetti P, Caterini R, Tudisco C. Longterm
Comparative Results in Patients with Congenital Clubfoot
Treated with Two Different Protocols. Journal of Bone & Joint
Surgery 85A(7):12861294.
2003 Morcuende JA, Egbert M, Ponseti IV. The effect of the
internet in the treatment of congenital idiopathic clubfoot. Iowa
Orthop J 23:83-86.
2004 Morcuende JA, Dolan L, Dietz F, Ponseti IV. Radical reduction in the rate of extensive corrective surgery for clubfoot using
the Ponseti method. Pediatrics 113:376-380.

.

.
.
16- .
,
,
.
17- ,
, . (. B) , , -
,
- . .
-
(. C) ,
. ( 475 ).

.
,
.
.
,
.
, .
, ,

.

, -

(),
.
.

, .
, 3-4
.
.
,
"". "" . . "" , . .

. , , , , ,
,
, ,
. ,
. .

, .
, .
(. D) .
. (. E)
. ()
(. F)
.

. , ,
, .
,
,
.
, ,
. .

7
. ,
. ,
. -
-.
. ,
.
, , . .
.
,
.
. , ,
, . ,
.
, .
. ,
. 5
.

, , ,
.
. , , , . - (. B) - (. ).
( ) (
). ,
.
( )
( ) .

, . , ,
,
.
3 ,
. .
, ,
().
, , .
35- .
. , 2005

8
,
?

?
, 6 .
( ).
, .
: 8- .

: ?
, 9
.
. 9 28 : -
.
.
: - ?
, , , .
, ,
: , - .
,
- , , , .
I .
?
(B).
.
(. . 7)
, . .
(. ) .

?
( 1,3 ) ( 0,4 ),
. , ,
( 2,3 ).
, .

,
?
,
3% 4%,
. ,
?
, - ,
( 7-10 ). 9 - 30%.
,
.

9
?
,
. ,
. , , .

?

. ,
, , .
, ,
, . .
, ?
, .
. 90%. , ?
- , , ,
, - ,
- , , .
.

?
, . ,
,
, .

,
. , .
. ,
, . -
, . .

?

().
?
.
, , (. )
.
(. D)
(),
3 .
(. ) 3-4 .
, , , (. F), .

10

(, , )
. . (. ). , (. B).
()

. , .. (. , ), - .

(. D E). ,
, .
, .


. ,
, .
, , .

. (. F).
- , - .
- ,
(
), . ( )
,
( ),
. ( )
. - , , .

11
.
,
(. ).
,
. ,
,
.
,
,
- .
. (. )
(
) ,
.
60 ,
.
(. B).
.

. .
, . . , ,
. ,
1,52 , .
.

(. ).
. ,
.
(). ,
.
() .
, .
,
.
. ,
(c. . D). ,
, . ,
.
, .

2
3
4

12

. , , ,
.
, , .

. (. ).
.
(. )
. , ,
.
. . - (. ) .
. .
, ,
. .

.
. .
,
,
.
, (.
). ,
,

.
- .
. .
. , .
.

(. F). (. G) , .
.
(. H),
- . .
.
,
. (),
.

13

, . , ..
.
, , , ,
- .

20 , .
(. ), , (. ),
. , (. ), , (. D).

, ,

.
,
- .

(. ). , , ,
.

-
,
- .
60
.

.
, 3- ,
.

,
,
.
. .
.

14

()

, (. ).

,
.

(. ).

.
.


(. D)
, . 1,5 ,
- . . (A)
. ,
.

20-25 (.
11 15, ).
, .

(. F) , 60-70
. . 3
.

3 .
(. G).
30, . .

15

2-3% .

.
(. ). ,
.
. , (. ).
.
.
.
, ,
.
. . ,
.
.
.
1,5 2 .

. .
. , , . ,
.

,

.

,
.
.
.
.
, .

60 .
, , , I , I .
.
, 120,
.
. ,
,
. 4-5 ,
.
(C).
.
.
, , . .
,
(D), . . ,
. .
, . .

16

, 3 .
, (. ). , ,
60-70,
30-40 (. ).
70. ,
. , (. ).
5-10 (. D).
3
.
12 2 4
,
14 16 .
, 3-4 .

(A), 60 - 70. 3 .

.
.
, 10 .
,
. ; ,
,
.
( )
. (D).

,
, . , , 80 %
.
, ,

, 6% (
).
.
.
.
, . ,
100 .
, - . ,
12 (. . 24). - , - . . , - . 3 . .
.
Markell, - ,
(. ). , .
, John Mitchel , , Wheaton,
. . ,
- 90.
.
,
.

17
. ,
, , ,

3-4 .

, ,
,
.
. , .
-
.
,
. , ,
, . , : , , , . , ,
.
, ,
.

,
. ( ) ,
. ( , , ). , , (. ).
10-14 . ,
. , 3 ,
.
, , .
,
,
. , ,
, .

(. B).

. 70 40.
?
. 4 ,

2 (. ). ,
, .
3-4
, , .
, . , 2- ,

.

. 2 ,
, .

18

,
.
Steenbeek
H.M. Steenbeek, Christoffel Blinden Mission
Katalemwa Cheshire Home , ,
, , .
, , , , . ,
. . steenbeck@nbi.ispkenya.com
Markell
. , .
,
.
, ,
.
, (B).
,
.
John Mitchel
John Mitchel
- . ,
, (C).
. ,
.
,
Markell
.
Gottenburg
- Romanus . ,
. ,
. (D).
, ,
.
Lyon
, (E).
. ,
,
.

19
, .

,
.
:
2 (
()
),
,
3 ( .
),
, 4 3 ( , (. ).
),
6 4 ,
2 .
. 1
2 . / , 4 , (metatarsus , adductus).
,
, - . , , . , - .
,
(. ). - , , (. ).
. ,
, - (. D), 12 24 ,
.
.

-
-
. (. . 26) () - , 2
6 % , 4 .
, 80 % , ,
. , - . , , , , - , 30 .
.
. :
,
! - , (- ).
, .
,
,
.

20

,
. . , , , . ,
3 5 .
.

- (. ).

-
(. ).

(. ). ,
.

(. D).

(. ). . - ,
.
:
, (. F). ( ).
(. G).

. ,
, (. ).
,
( ).

21

(. ).

,
,
(. ).

,
(. ),
.

, 10 (. D) - .

(. ) .

, (. F).
.

(. G) (. ).

.
4-6 .
.
6 .

22

.
,
2 .
, .

( )
,
/ , ,

.
.
0
0,5
1


(MS), 0 3.
(. )
(. )
(. )

(HS),

0 3.
(. D)
(. E)
(. F)

1.
.
2. ,
,
,
.
3. , HS>1, MS<1 .
: Piras@aol.com

23

, .
, .
,
. !
,
.

.
. ,

, .

.

.
1. ,
. , ,
.
2. . .
3. -.

,

. . -, . , , , .

, .
,
, (.. )
.
- ( )
.

24

100000
, 80% .
.

, . , , .
, , , .
.
,
.
2% .
, , .
. ,
, .

. ,
.

1000 12 .
,
. -
.
Can We Make a Difference? (
2001), ... .
,

,
1999 . , , (B), . - ,
() . ,
, ,
, . , 3-
. .

25

,
( Makerere; ;
)
. (
).

,
.
.

110 32 53
6
.
.

,
Mulago ( ) 1999 . 2002 . 118
(182 ).
, 176
182 (97 %) 6 182.
37 (23,4 %) ,
.. - , ,
, .
- .
,
- , (. .
, , ) (, ).

- , , , ,
, - .
, -
, .
.
.

26

?

,

.
1
1000 .
,


. ,

1
30. , ,
,
.
.


1 ,
, , .
.
.
.
,
.

6 4
. ,
, (
). .
, .
. () , .

. .
.
.

.
, , , . ,
.

,
.
,
:
,
,
,
(. ),
(. ),
38,5C
()
5-7
. 2-3 , , . .

,
,

15-20 .

(
, ),
, , (. ).
,
. , ( ).

27

.
. .
( ) 3-4
.
, .
.


.
,
, .
(.
).
,
.
.

.
60 70, (
) 30 - 40. 23
3 ,
2 4 .

, ,
. , ..
100% .
.
.
.
4 .
90 % .
(, ).

-, . ,
. .
,

. ,
,
. , , .
, , ..
.
,
.
,
.
. .
,
. : . , .
, .
, , , .

28

5-10 % ,
, , 2 . , - , . .
,
.
.
, -
. ,
. , .
.
, , . . . , , .
.

.
, - ?
. , , , .
, ,
. .
. . - ( ,
- 1 .).
. , , , 1-3 . .
. , .
.
- .
, .

,
.
, :
a. .
. .
. (
).
. .
. .

3-4 2
, .

.
- ?
.

2-3 ,
. .
, ,
,
3 .
.

,
, ,

.

,

.

29

, . 1997

. 20
- .
. . ,
, , 1999 . martinegbert@earthlink.net

:
http://groups.yahoo.com/group/nosurgery4clubfoot
:http://www.steps-charity.org.uk/
forum/home.html
: http://ifrance.com/piedbot/
: http://www.klumpfuss-info.de/
: http://groups.yahoo.com/group/kampurat/
: http://www.peboto.grupos.com.pt/
: www.piezambo.com
: http://www.petorto.com.br/
:http://forum.materinstvo.ru/index.php?showtopic=78787

:
http://www.uihealthcare.com/news/pacemaker/2002/fall/ponsetti.
html
:
http://www.vh.org/pediatric/patient/orthopaedics/clubfoot/index.ht
ml
:
http://groups.yahoo.com/group/clubfoot
http://messageboards.ivillage.com/iv-ppclubfoot
:
http://www.rfasyar.ru
http://www.datahaus.net/family/Graham/CF/
http://community2.webtv.net/joybelle15/ROSESCLUBFOOTPAGE/
http://members.aol.com/vc11/
: ,
.

30

,
,
.
, Global HELP organization. , ,
40 . , , ,
. ,
global-help.org.
,
, Global HELP,
.
. .

Susan Elliott, Lars Jonsson, Paul Merriman, Lana and Lynn
Staheli.

Charlene Butler, Lynn Staheli Selim Yalcin.
David Spiegel Hugh Watts.

Nadire Berker, Selim Yalcin Muharrem Yazici.

Henry Cindy Burgess, Vickie Dorm Cooley, Susan Elliott
Travis Burgeson, George Hamilton, Lars Laurie Jonsson,
Peter Mason Roberta Riley, Paul Suzanne Merriman, Tom
Floret Richardson, Lana Lynn Staheli, Diane Adachi, Alan
Honick, Katherine Michaels, Brandon Perhacs, Kate Drakos,
Betti Ann Robert Yancey, Hugh Watts Irving Judith
Spiegel, Dan Johnson Dori Kelly, Jeff McCord, Pam Little.

31

.
PDF
PDF . global-help.org.

- .

. .

18x24
.

32

. 1 1000
.
100000 .

. ,
, , ,
.

35

, ,
.
.

Global-HELP (GHO) , , ,
.
Global-HELP , , , . , , .

Global-HELP ,
: www.global-help.org