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Clubfoot and the Ponseti technique

: © CBM
Esther, from Uganda is six years old. She was operated on for clubfoot by CBM partner CoRSU and can now fulfil her dream of going to school.

Information about the congenital condition clubfoot, its treatment using the Ponseti technique, and the Global Clubfoot Initiative.

What is Clubfoot?

Clubfoot is a common congenital condition that causes the foot to twist inwards and upwards. It often occurs in both feet. If it is not treated at a young age children walk on the top or sides of the foot and suffer significant disability. Clubfoot deformity causes pain, difficulty walking and inability to wear normal shoes.

In many countries people with clubfoot impairment are less able than their peers to attend school or earn a living and may face stigma and exclusion from social activities. Many such children are identified in community projects that CBM supports.

Out of all the cases of clubfoot worldwide every year it is estimated that 80% of children with clubfoot are born in developing countries where resources are inadequate to meet the need of appropriate medical care.

CBM and clubfoot

CBM has assisted its partners around the world in clubfoot care for many years. In 2010 CBM supported more than 3,000 surgeries for children with clubfoot deformity and more than 20,000 manipulation therapies. Support for surgeries has been necessary because many older children with severe deformity were unable to obtain early intervention services.

Treatment – the Ponseti technique

Until recently, clubfoot was considered a very difficult condition to treat; various non-surgical and surgical methods of treatments were used, most of which resulted in less than satisfactory results. However, a treatment method called the Ponseti technique now offers hope to children with clubfoot. When applied correctly, this technique can correct the clubfoot deformity in up to 95% of cases.

The Ponseti technique consists of a series of manipulations and castings of the foot, a small surgery called a tenotomy and an extended time of keeping the feet in a specially designed brace to hold the feet in the corrected position. It is important that babies are identified and treated early in life to get the best results.

The Ponseti technique is particularly appropriate to developing countries because it can be taught to paramedical staff rather than orthopaedic surgical specialists who are in very short supply.

In 1999 the Ponseti technique was introduced into Uganda by CBM co-workers. The Uganda Clubfoot Project, with national and international stakeholders, rapidly developed into a model project for the implementation of early intervention, training and clubfoot service delivery on a national scale.

The 'ten country' programme implementing the Ponseti technique

In 2007-2009, CBM was one of three partner organisations, along with Cure Clubfoot Worldwide and the Ponseti International Association, participating in a programme which supported the implementation of the Ponseti technique in ten different developing countries.

This programme used a standardised approach to establishing and supporting national programmes for clubfoot.

CBM partners in Ethiopia, Malawi, Zambia, Tanzania, Rwanda, Haiti, Honduras, Paraguay, Laos and Nepal were involved in teaching, learning and applying the Ponseti technique in partnership with Ministries of Health. In all, during the two years, 630 providers were trained in the Ponseti technique, 112 treatment centres established and over 7,700 babies enrolled for treatment.

In many of these countries the Ponseti technique is now considered the treatment of choice for clubfoot and is being used to great effect bringing hope to thousands of children born with clubfoot.

CBM continues to support similar Ponseti clubfoot initiatives in Uganda, Kenya, and India.

Global Clubfoot Initiative

CBM co-workers have gained great experience in early intervention programs for clubfoot deformity and are in demand as advisers and trainers in many countries and programmes. They regularly are invited to present their experience and results at major international conferences.

In order to continue to further the treatment of children with clubfoot around the world, CBM is now a governing partner in an organisation called the Global Clubfoot Initiative. This initiative will provide training and information resources for organisations providing treatment for clubfoot in developing countries.

Most importantly, because of CBM’s support for clubfoot care around the world, thousands of children will be able to receive the early treatment they deserve and will be spared suffering, disability and exclusion from normal community activities. They will instead have the hope of ‘normal’ feet that allow them to run, jump, play, attend school and enjoy a quality of life equal to that of their peers.