Clubfoot

Clubfoot (or Congenital Talipes Equinovarus) affects 1 child in every 1,000 born around the world.

A young child from Papua New Guinea with bilateral clubfoot. Photo: CBM/Mannion

Most commonly, clubfoot occurs when the position of the foot points downwards and inwards. Clubfoot can affect just one or both feet. Other forms of clubfoot involve the foot turning upwards, or outwards.

There is very little evidence available about the causes of clubfoot, however the prevalence rate is higher in boys than girls.

80% of these children live in poor countries where lack of access to adequate treatment means that the number of children growing up with clubfoot disability is higher than in countries where the impairment is treated at birth.

If early identification and treatment does not happen, the bones and joints in the foot harden as they grow and children begin to walk on the side or top of the foot.

Clubfoot Treatment

Surgery

In poor countries, if there are surgical resources, the treatment of clubfoot at infancy has generally been through surgical methods where the bone is re-set and the soft tissue released.

Although this surgery can be carried out with relatively basic surgical equipment, it does require a lot of follow up care. It is important that it is done in collaboration with an infrastructure of rehabilitative and post operative care - and in many poor countries this is not available and the risk of infection and of incomplete treatment leading to a relapsed clubfoot is high.

The Ponseti Method / non-Surgical

In recent years, the non-surgical Ponseti method of treating clubfoot has been re-introduced and has gained popularity in both resource rich and resource poor countries. The method is named after its pioneer - Dr Ignacio Ponseti (1914-2009).

The Ponseti Method is a non-surgical way of treating clubfoot, and can be implemented by a health worker. Photo: CBM

The Ponseti method uses repeated manipulation and casting of the clubfoot at infancy and is non-invasive so does not carry such a risk of infection. Although it requires attention every time a new cast is set, it is more appropriate for developing countries where the ratio of orthopaedic surgeons to the population is very low.

In countries like Uganda, where the Ponseti method has been launched in nationwide programmes, it has been accompanied by massive public health education and awareness campaigns to facilitate increased knowledge about clubfoot and the early identification and referral of children born with clubfoot.