The steps Jane Bettridge Fellowship fund (JBF) helps to introduce the Ponseti Method of treatment for clubfoot in Bulgaria

Our links with Bulgaria began in 2003 when we funded a travel Bursary which enable Miroslav Zhivkov, an orthopaedic surgeon from Varna, to give a presentation at the 2nd International Clubfoot conference in Manchester about his work with the Ponseti Method in Bulgaria. At the time Dr Zhivkov was a lone practitioner of the method and was self taught using the Internet and correspondence with Dr Ponseti. Most children in Bulgaria were treated using the traditional method involving physiotherapy and open surgical procedures. Over the years a few other doctors began to use the method with good results, but is was still not accepted as mainstream treatment and routinely taught in medical schools.

In May 2006 the Bulgarian Orthopaedic and Traumatology Association (BOTA) held a Satellite Ponseti Course with a faculty from the UK, Naomi Davis, Manchester, Gavin de Kiewiet, Sunderland and Catherine Duffy, Belfast and a Bulgarian faculty including Dr Zhivkov and parent Natalia Nikolova. The JBF funded the travel costs of the visiting Faculty and I combined the visit with Annual Leave.

The day was run in the tried and tested method that has been developed in the UK with formal presentations and practical workshops, so there was plenty of opportunity for hands on experience. Delegates were mostly from Bulgaria, but there were also visitors from Macedonia and Turkey.

There was a lot of debate over whether the method was really suitable for severe intractable clubfoot especially over the correction of tibial torsion. In many ways the responses reminded me of attitudes in the UK six years ago with an "establishment" unconvinced of the efficacy of the technique and a group of dedicated practitioners who were convinced and determined to prove that the method should become one of the mainstream options.

However the expertise and knowledge of the team from the UK must have made an impression as at the end of the conference the Chairman of BOTA, Prof Tivchev (Head of BOTA) offered the topic for the next conference in 2008 to adopt a National Standard of Clubfoot Treatment based on the Ponseti Method and the "TSF Frame" for the small number of feet that do not fully respond to Ponseti Method.

Miroslav Zhivkov says,

"Without your (steps) help, it would not have been possible to raise the awareness of the local community in accepting new (for Bulgaria) alternative treatments for clubfoot patients"

I feel certain there will now be more options for children born with clubfoot in Bulgaria to have a minimal surgical treatment and I feel privileged to have been part of that meeting and that steps has been able to make a small difference.

Sue Banton

Director & Founder, steps

May 2006