3 June 2021
3 June 2021 is World Clubfoot Day. Designed to raise global awareness of clubfoot, this day is of specific significance in southern Africa, where more than 11,000 children are born with clubfoot each year. Around 2,000 of these children are born in South Africa. Around 150,000-200,000 children globally are affected annually, and the incidence rate in southern Africa is considered to be higher than average. According to studies, it is second highest in the world.
The specific date was chosen to celebrate the birthdate of Dr Ignaçio Ponseti (2014-2009), a Spanish orthopaedic surgeon who lived in Iowa USA, and developed a non-surgical method for treating clubfoot in the mid-20th century. The ‘Ponseti Method’ consists of using a series of casts, gentle manipulation and the use of a clubfoot brace. This was a ground-breaking method as, for the first time, clubfoot could be corrected without surgical intervention, with a more effective and economical technique.
Stories of hope
There are lots and lots of success stories sent to us over the years. Feel free to enjoy them all here:
We’re also sharing 30 stories in 30 days on our social media pages, so please join our communities at:
Clubfoot treatment during a pandemic:
We’ve all experienced the constant change that has been the result of the pandemic that arrived in South Africa in early 2020. We felt that it was important for us to share with everyone how the STEPS supported clinics have gone above and beyond duty to ensure that clubfoot treatment could continue.
We’ve split this into Q&A sections so that you can easily browse through the detail.
How many clinics were closed during lockdown?
28 out of 34 clinics. In 2020, most clinics were closed during Lockdown Stage 5 and 4, and some for weeks after that for various reasons, including limited clinic staff, lack of space, lack of COVID-19 safety resources, or COVID-19 numbers rising in specific areas, e.g.:
- George Mukhari Academic Hospital closed for nearly 5 months because of casualty being closed to deal with COVID-19 cases
- Frere Clubfoot Clinic closed for nearly 4 months because of the high number of COVID-19 patients
All clinics apart from 6 (1 in Gauteng, 3 in the Western Cape and 2 in Kwa-Zulu Natal), were closed for at least one month.
The COVID19 second wave in Dec 2020-Feb 2021 caused clinics to close or operate at reduced capacity, e.g.:
- George Mukhari Academic was closed from 17.12.20 and only reopened in March 2021.
- Themba Clubfoot clinic in Mpumalanga has been closed since 17.12.20. The clinic space is being used for COVID-19 patients.
Which clinics closed permanently during 2020/2021?
None
Which clinics operated throughout lockdown, with no closures?
- Western Cape: Tygerberg Hospital, Maitland Cottage Children’s Orthopaedic Hospital, George Hospital
- Kwa-Zulu Natal: Greys Hospital, Madadeni Hospital
- Gauteng: Chris Hani Baragwanath Academic Hospital
How many children were treated in 2020 at STEPS partner clubfoot clinics?
Jan-Mar 2020
- New patients enrolled: 221
- Total Patient clinic appointments: 3430
Apr-June 2020
- New patients enrolled: 118
- Total Patient clinic appointments: 2399
July – Sept 2020
- New patients enrolled: 173
- Total Patient clinic appointments: 2895
Oct-Dec 2020
- New patients enrolled: 166
- Total Patient clinic appointments: 3122
Jan-Dec 2020
- Total patients treated: 3079
What do the patient numbers look like to date for 2021?
Jan-April 2021
- New patients enrolled 272
- Patient visits: 4486
How did all of the clinics work within restricted opening hours?
- There were no elective surgeries performed.
- No new patients were enrolled, only those that had already started treatment could continue.
- Follow up appointments for patients in braces were postponed.
- To limit patient numbers, most clinics opted for two-weekly follow-up Ponseti casting instead of weekly.
- Follow up brace appointments were every 6 months instead of every 3 months.
- They operated with limited staff as many health professionals had to help with Covid-19 ward rotation (at the Livingstone clubfoot clinic, clinic staff rotated on the Covid-19 wards).
- Many operated with reduced clinic space as some clinics shared space or gave their space to Covid-19 wards:
- Charlotte Maxeke Academic Hospital shared their space with a paediatric Covid-19 ICU ward.
- Themba clubfoot clinic closed for 4 months as the area was turned into a Covid-19 ward
How are clinics managing the safety aspect?
- Only one adult is allowed in with each child/patient.
- Patient caregivers have to wait outside the clinic and are admitted individually.
- Each patient and caregiver entering the hospital is Covid-19 screened before being allowed into the clubfoot clinic.
- All caregivers must wear masks and most children over one year old also wear masks.
What have the treatment backlog ramifications been and how are they being coped with?
- For those patients that outgrew their clubfoot brace and stopped wearing them, they have had to be assessed for recurrence before new braces are supplied and fitted.
- Some patients went into temporary retention casts to wait for emergency brace stock due to hospital procurement delays.
- Some patients have had to restart treatment from the beginning.
- Many patients have regressed and needed more casting before a tenotomy can be done.
- Some patients whose families were wary of public transport or did not have funds, have been supported with hospital transport and some individual urgent cases were supported from the Steps Uthutho Fund launched in June 2020. Unfortunately, there have not been enough funds to help them all.
- Parents who lost their jobs and moved to other towns have contacted STEPS for information where to access treatment.
