A global strategy to ensure that children born with clubfoot lead pain free and normal lives

Steve Mannion.
Author:Steve Mannion
Posted on: Saturday, 3rd June, 2017

On World Clubfoot Day, Steve Mannion, CBM’s Orthopaedic Advisor highlights the impact of clubfoot on children’s lives and why the new Global Strategy to End Clubfoot Disability launched today is so important.

4 year old Sylas born with clubfoot undergoing treatment. Field worker Agnes Nabawanuka teaches some exercises.

Congenital talipes equino-varus, or clubfoot, is the most common significant musculoskeletal congenital abnormality, affecting between 1 and 2 babies in every thousand live births. The deformity presents as a “twisted” foot, with the sole of the foot turned upwards and the ankle twisted inwards. The condition is twice more common in boys than girls and in two thirds of cases both feet are affected. Without treatment, the child will begin to try to walk on the deformed foot, which with time will become stiff and painful. Also the bones of the foot will secondarily deform making correction more difficult and often only possible by means of extensive and costly surgical procedures. Without correction, mobility is impaired, leading to children having difficulty attending school and participating in regular childhood activities. Normal shoes cannot be worn and as adults employment opportunities are limited.

Clubfoot deformity is entirely correctable by a low-cost and simple technique known as the Ponseti method. This involves a weekly manipulation and plaster casting of the foot, which typically corrects over a period of 5-6 weeks. The majority of cases need a minor surgical procedure, under local anesthesia to release the Achilles tendon before a final cast is applied which is worn for a period of three weeks. When that cast is removed the fully corrected position is held by an inexpensive, often locally produced brace worn virtually full time for 3 months and then at nights only up to 4 or 5 years of age.

2 year old Archana receives treatment for clubfoot. Globally, nearly 200,000 children are born with clubfoot deformity every year and the majority of these are in low and middle-income countries where it is difficult for them to access treatment; of those born today only 15% are likely to be corrected, condemning the remainder to life-long pain and disability. CBM has been in the vanguard of the drive to establish Ponseti based clubfoot treatment programmes across the developing world.

In 2002, Chris Lavy and I working for CBM in Malawi, established one of the first national Ponseti based clubfoot treatment projects in Africa and CBM expert Norgrove Penny did likewise in Uganda. CBM’s advisor and physiotherapist, Michiel Steenbeek, designed an inexpensive brace which can be produced locally in developing countries and is critical to maintaining the correction achieved by manipulations.  Along with our partners around the world, CBM has gone on to set up Ponseti based clubfoot treatment programmes and as a result we have transformed the lives of children born with this condition. CBM has also been at the forefront of teaching and training local doctors in the specialized surgical techniques necessary to treat older children and adults who have had clubfoot for some time.

Very much in the spirit of our moto “Together we can do more” CBM was a founding and governing member of the Global Clubfoot Initiative (GCI), an umbrella organization of non-governmental organisations involved in clubfoot treatment worldwide. Through GCI, CBM has helped develop a standardized training package for clinicians treating children with clubfoot and a global database of cases treated.

Despite our successes there is still much more that needs to be done.  There are countries around the world today without a Ponseti based national clubfoot treatment programme and up to 85% of children born with the condition worldwide are unable to access treatment. CBM has thus collaborated with GCI on the drafting of a Global Strategy to End Clubfoot Disability, which is published today, 3 June 2017, World Clubfoot Day and the birthday of the late Professor Ignacio Ponseti who pioneered the successful treatment technique. This strategy has prioritised countries in which programmes need to be established and developed, as well as estimating the costs involved in doing so. Under this strategy we hope that, by 2030, 70% of children born with clubfoot in developing countries will have access to the treatment they need in order to walk and run free for the rest of their lives. CBM, via our partners worldwide, are already a major provider of clubfoot treatment internationally and intend to take a leading role in the implementation of the global clubfoot strategy published today.

Resources:

Ending Clubfoot Disability - A Global Strategy

One-Page Summary - Global Clubfoot Strategy

Watch the Global Clubfoot Initiative #RunFree2030 video

For more information on clubfoot, its treatment using the Ponseti technique, and the Global Clubfoot Initiative, visit www.cbm.org

Images (top to bottom)
4 year old Sylas who was born with clubfoot receives treatment in Uganda.
Archana, 2 years old, receiving clubfoot treatment in Nepal.

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