Clubfoot has been a recognised condition since ancient Egypt. Pharaohs Siptah and Tutankhamun had clubfoot, Hippocrates and the Aztecs described the condition.
Clubfoot is the most common musculoskeletal birth deformity affecting 200 000 babies each year, but many people are not even aware of the condition, what causes it, or how it is treated. Studies report that the Southern and East African population have almost twice the world average incidence of clubfoot. There are almost 11 000 children born with clubfoot in Southern Africa every year.
Clubfoot causes children to be born with one or both feet turned inward and upward. The foot is usually short and broad, curved in a bean shape with a deep crease on the sole because of the curve. The heel feels spongy because the tight Achilles tendon pulls the heel bone in. The calf muscles are often smaller and less developed. Without treatment the top of the foot is where the bottom should be, and the feet become fixed in this position, which makes walking either impossible or very painful.
Many older children live with the burden and stigma of neglected or relapsed clubfoot. Neglected clubfoot has a long-term impact on a child’s quality of life. Children in rural areas or depressed socio-economic conditions are more affected by the lack of access to adequate care or information. These children face a life of disability due to untreated clubfoot.
The Ponseti Method is over 95% effective when properly applied by a trained health care provider and is considered the “gold standard” treatment, leading to a normal, productive life.
The Ponseti method, devised over 60 years ago by Dr Ignacio Ponseti, avoids cutting the tight ligaments, tendons and joint capsules. It is a carefully constructed sequence of plaster casts and braces for children with clubfoot, based on his studies of the condition. Long-term follow-up studies show superior results to operative techniques.
Typically the method takes about four to six weeks of plaster casts, changed every five to seven days. For over 80% of cases, the tight Achilles tendon is cut in a minor procedure (tenotomy) and the corrected foot is put in a holding cast for three weeks to allow the tendon to regenerate longer.
When the final cast is removed, a clubfoot brace is fitted – a pair of shoes attached to an adjustable bar at a specific width and angle. The child wears these at night for four years.
Clubfoot in Southern Africa
STEPS SA is the only NGO in southern Africa focused on the effective treatment of clubfoot. STEPS’ South African Ponseti training courses for clubfoot treatment were well supported by paediatric orthopaedic surgeons and have significantly revolutionised clubfoot treatment in South Africa. The Ponseti Method is endorsed as best practice by SAPOS (South African Paediatric Orthopaedic Society). Following the successful introduction of Ponseti to South Africa, STEPS has also organised training courses in Namibia and Botswana, and works with local partners and stakeholders to build capacity for clubfoot treatment in their countries.