For decades, clinicians in the Foot and Ankle Deformities Program at Seattle Children’s have strongly influenced guidelines for pediatric orthopedic foot care worldwide.
Physicians in the Foot and Ankle Deformities Program specialize in treating children using a principles-based approach, developed by Dr. Vincent S. Mosca, pediatric orthopedic surgeon at Seattle Children’s and professor of orthopedics at UW Medicine, during his 32-year career at these institutions. This approach is now considered the foundation for modern management of pediatric foot and ankle deformities and has enabled Seattle Children’s physicians to improve care for children not just in the Pacific Northwest, but all over the world.
Treating children case-by-case
The approach requires physicians to factor in the complexity and variability of pediatric foot deformities before developing individualized treatment plans and algorithms that address the severity and progression of a condition. Physicians also need to take into account the effects that growth, development and previous procedures have on treatment outcomes.
“Until this approach was developed, orthopedic surgeons used to see a condition and perform the operation they usually would, often without thinking about the subtleties of a particular foot or child,” Mosca says. “The results are much better if you evaluate each case individually and choose specific procedures that will help that individual child’s foot.”
His approach is applied in both the Foot and Ankle Deformities Clinic, where children receive treatments for a range of congenital and developmental foot and ankle problems, as well as the Lower Limb Differences Clinic, which specializes in helping children who are missing part or all of a lower limb through the use of prosthetics, physical therapy and surgery.
Recently, the individualized approach has been applied to research in the functional outcomes for children with fibular hemimelia who undergo amputation rather than limb lengthening.
Early leaders in innovative treatments
Mosca set the standard for management of pediatric flatfoot using a treatment method he developed – a variation of the Evans procedure – that involves calcaneal lengthening. His is now the preferred method used around the world for addressing symptomatic flatfoot in children and adolescents. He, along with pediatric orthopedic surgeon and colleague, Dr. Maryse Bouchard, continue to develop and assess local treatment protocols and outcomes.
Seattle Children’s was also one of the first hospitals in the nation outside Iowa City to utilize the Ponseti method to treat clubfoot and one of the first programs where a specially trained pediatrician, Dr. Thomas Jinguji, performs Ponseti casting along with Mosca and Bouchard. Having Jinguji perform such casting improves access to and speed of care for children who need their casts changed weekly.
An emphasis on education
The program’s physicians participate in eight to 12 national and international meetings each year to teach their methods to other providers. Seattle Children’s also sends ambassadors to other countries to share techniques and principles with local doctors. Bouchard recently returned from Vietnam, where she trained practitioners in the Ponseti method through Mobility Outreach International.
“We do all of our research and speaking so doctors can do what’s best for their patients, in their communities,” Mosca says. “That said, we’re available to care for a child if a doctor believes a certain procedure is beyond their expertise.”