The topic of your MSc thesis on SOTE-ETK was the treatment of babies born with clubfoot. Can you please share the focus and conlusions of your research?
The focus was the scientific studies from the last 10-15 years that compared the results of conservative vs. surgical treatments and the comparison of various conservative treatment types. (Zapata and Co, 2018; Sala and Co, 2013; Karol and Co, 2016). The professionals performing the examinations prefer the conservative treatments vs. the surgical ones. (Zapata and Co, 2018). The comparison between the French functional method, which involves no surgery and the Ponseti method, which has minimal surgical intervention show that the children treated with the Ponseti method come closer to the normal physiological range of joint movement, while the children treated with the French functional therapy surpass those treated with the Ponseti method when it comes to the quality and development of their gross
motor skills and gross motor function (GMS and GMF) (Karol and Co, 2016). The most important note for us (physiotherapists) is that the Ponseti method is an excellent way to correct the deformed structure of the foot, but it doesn’t help sufficiently with the body’s complete gross motor functions. The studies do not focus on measuring the development of the gross motor functions, as a result it is not apparent for
them that the distortion of the kinetic system of the lower limbs (the coherent functional connection of the joints of the lower limbs) exists already in the beginning of the development of the motor skill patterns (onthogenesis of the motorium). Meaning out of an incorrect set of motor skills only incorrect motion patterns can result. (crawling, sitting – W shaped sitting) The French treatment identifies the problem of the difference in quality of the motor skills of children with clubfoot and those treated with the French method. (Zapata, Karol and Co, 2018; Karol and Co, 2016) The studies highlight this problem, but they do not provide any recommendations for resolving this.

How does the treatment change with the growth of the baby (when can it actively participate in the treatment)?
In my opinion if the clubfoot is not accompanied by any other syndrome there is no need for any other therapy. The natural development of age-appropriate motion patterns (in some cases exercises supported by special tools) are the therapy within themselves. In case of need however as the child gets older, regular contact with the physiotherapist can ensure prevention and correction of any deviation from the
normal by learning specific exercises.

When is a clubfoot patient considered ‘healed’?
From the perspective of the physiotherapist: In case of proper correction of the foot, with all the systems serving the optimal functioning of the motorium, (by the ages 6-7) the foot as an anatomic unit completes its physiological development and there should not be any significant deterioration of its condition.
Doctor colleagues also consider it important to mention that during treatment they aim to reach healthy characteristics, but it must be made clear that this doesn’t mean a 100% physiological state. As a parent one has to carefully monitor the child’s foot. In my experience by the time the check ups get less frequent, parents of clubfoot children become sufficiently trained and will know what is needed to be able to evaluate the current status of the foot. What this means is that if you see any deviation, make sure you get in touch with your therapist or doctor, what it definitely doesn’t mean though is that you mustn’t make your own conclusion on the change.

What makes the Dévény method stand out when treating clubfoot patients?
„Look at what everyone is looking at, and see what no one else has seen.” Thomas W. Myers
This quote represents the secret to the Ponseti method’s and the Dévény technique’s success and unique effectiveness. To understand determining connections we need to look at the human body at its complexity, while putting its functionality in the forefront. These connections remain hidden for therapies that only focus on a specific part of the body. This nature of experiencing helps recognise and observe the
functional pathomechanism, which forms the backbone of my thesis too.

When should the Dévény treatment be started in case of clubfoot?
The DSGM therapy should ideally start at the same time when the patient starts wearing the boots and bar (in certain cases it is possible to start during the casting period, while this is really good, it is not a problem if it is not happening). If we consider the phases of the Ponseti-treatment, the 23 hour bracing period starts at the time when voluntary movements of the gross motor skills start to appear. (3-3.5 months – this is a very sensitive period for the development of the central nervous system)

Can you please share a few things about you and your professional background?
My name is Orsolya Türei, licensed physiotherapist (MSc in physiotherapy) and DSGM specialized physiotherapist. I have been working at the Heim Pál Children’s Hospital for nearly 20 years now. My clinical speciality is pediatric orthopedia and as a result of my specialized qualification pediatric neurology.

How did you become aware of the Dévény method and the Ponseti treatment?
Clubfoot (pes equinovarus congenitus) is one of the most common orthopedic birth defect, I encountered it in our hospital where the doctors apply the unique Ponseti method to treat it.

The correctional system of Ignatio Ponseti is a primarily conservative way of treatment. It’s success comes from the fact that the treatment plan is relying on the biomechanical knowledge of the foot.
This functionality motivated me to dive deeper and learn more about it. Apart from this by 2010 I learned a unique physiotherapy method: Dévény Special Manual Technique & Gymnastics Method (DSGM), the unique outlook of it further allowed me to develop my systemic approach to clubfoot treatment. Our Hospital is a Ponseti treatment centre, the number of clubfoot cases I encountered and the special approach of the Dévény method on interpreting the pathology of the human body, together served as a foundation for my MSc diploma thesis. It is titled THE ROLE AND RELEVANCE OF THE DÉVÉNY METHOD WHILE CORRECTING CONGENITAL CLUBFOOT WITH THE PONSETI TREATMENT, after the evaluation I have received an excellent grade on it in 2020. I hereby would like to thank all the families for their support who answered the questionnaire I posted earlier.

Could you please explain in plain words the different between SMT and STG?
This original therapeutical method has been developed by physiotherapist and rhythmic gymnastics coach Anna Dévény (1935-2017) since 1976, based on the experiences of her two professions. Dévény Special Manual Technique & Gymnastics Method (abbreviated as DSGM) is a new therapeutic method in motion rehabilitation proven by several decades of practical experience. It builds on a new approach, applies radically new technical elements and implementation, therefore it opens new, previously unknown opportunities in medication.
DSGM covers two main fields of application: DSGM I.-, and DSGM II.
(source of translation: https://dsgm.eu/en/deveny-method/)