Clubfoot Care in Low-Income and Middle-Income Countries: From Clinical Innovation to a Public Health Program

  title={Clubfoot Care in Low-Income and Middle-Income Countries: From Clinical Innovation to a Public Health Program},
  author={Luke S Harmer and Joseph J. Rhatigan},
  journal={World Journal of Surgery},
BackgroundClubfoot occurs in nearly 1 in every 1,000 live births worldwide, representing a significant burden of disease. In high-income countries, an evidence-based treatment protocol utilizing sequential casting was pioneered by Ponseti and has resulted in excellent outcomes among children treated for this condition. However, treatment methods and results of treatment vary greatly across low- and middle-income countries (LMICs). Our goal was to create a framework for understanding how… 

What factors impact on the implementation of clubfoot treatment services in low and middle-income countries?: a narrative synthesis of existing qualitative studies

BackgroundAround 100,000 children are born annually with clubfoot worldwide and 80% live in low and middle-income counties (LMICs). Clubfoot is a condition in which children are born with one or both

The Health Determinants of Accessibility to Clubfoot Treatment in LMICs: A Global Exploration of Barriers and Solutions

While considerable progress has been made in building capacity for the treatment and management of CTEV in LMICs, structured training programs that support conservative manipulative methods to manage CteV should be initiated globally.

Eight-year Review of a Clubfoot Treatment Program in Pakistan With Assessment of Outcomes Using the Ponseti Technique: A Retrospective Study of 988 Patients (1,458 Clubfeet) Aged 0 to 5 Years at Enrollment

Higher education of the head of household and male sex of the child were markedly associated with improved outcomes in foot correction status and a statistically significant reduction in Pirani scores was noted.

A Community Audit of 300 “Drop-Out” Instances in Children Undergoing Ponseti Clubfoot Care in Bangladesh—What Do the Parents Say?

The parent load indicator, in parallel with the initial clubfoot severity assessment, may help clinicians to better appreciate the demand that treatment will place on parents, the associated risk of drop-out, and the opportunity to enlist support.

Romanian patients’ access to clubfoot treatment services

It is concluded that more efforts need to be done for the diagnosis and treatment of children with clubfeet, including actions which are focused on raising awareness around this abnormality and more well-developed treatment guidelines.

Factors Affecting Parents to ‘Drop-Out’ from Ponseti Method and Children’s Clubfoot Relapse

Relapse occurred in 15/72 drop out cases, predicted by problems with casting and predicted worse foot posture and reduced physical functioning, and probably lowering the overall relapse rate with inclusion of ‘postural’ cases.

Diagnosis and Treatment of Idiopathic Congenital Clubfoot.

An important factor in the ultimate success of the Ponseti method is parental understanding of the bracing phase, and there is a very high rate of recurrent deformity when bracing is not done properly or is stopped prematurely.

Determination of Relationship Between Ponseti Method of Clubfoot Management and Age of Treatment Onset

It is recommended that clubfoot is ideally treated within the age bracket of 0-6 months to prevent relapse, increased duration of treatment and too much serial casting and also promote a society with reduced rate of clubfoot deformity, thereby reducing need for future bone correction surgery, and reduced direct effects of late management of club foot on the child’s family.

Oral Sucrose for Pain Relief During Clubfoot Casting: A Double-Blinded Randomized Controlled Trial

Sucrose solution and milk during Ponseti casting and manipulation were effective in decreasing the pain response in children undergoing manipulation and casting for clubfeet.

The feasibility of a training course for clubfoot treatment in Africa: A mixed methods study

The Africa Clubfoot Training package to teach health care workers to manage clubfoot is likely to be feasible in Africa and future work should evaluate its impact on short and long term treatment outcomes and a process evaluation of implementation is required.



Club foot treatment in Malawi – a public health approach

The establishment of a nationwide club foot treatment programme was of benefit to a large number of children with club feet and their families, and in a poor country with many demands on health funding many challenges remain.

Towards Effective Ponseti Clubfoot Care: The Uganda Sustainable Clubfoot Care Project

The 6-year Uganda Sustainable Clubfoot Care Project (USCCP) aims to build the Ugandan healthcare system’s capacity to treat children with the Ponseti method and assess its effectiveness, and is following a cohort of treated children to evaluate its effectiveness.

Evaluation of the utility of the Ponseti method of correction of clubfoot deformity in a developing nation

The results show that corrective surgery, sometimes multiple, can be avoided in most cases which are usually associated with the development of a stiff, painful foot and the Ponseti method of correcting clubfoot is especially important in developing countries.

Barriers experienced by parents of children with clubfoot deformity attending specialised clinics in Uganda

Clubfoot is a congenital structural impairment that, if untreated or inadequately treated, leads to deformity. Effective management is dependent on the compliance of parents to the treatment for

Early clubfoot recurrence after use of the Ponseti method in a New Zealand population.

Examination of the early rate of clubfoot recurrence following the use of the Ponseti treatment method in a New Zealand population found compliance with the postcorrection abduction bracing protocol is crucial to avoid recurrence of a clubfoot deformity treated with the PONSeti method.

Update on Clubfoot: Etiology and Treatment

An update on the etiology of clubfoot as well as current treatment strategies are provided and a combination of approaches that applies the strengths of several methods (Ponseti method and French method) may be needed.

Clubfoot Treatment: Ponseti and French Functional Methods are Equally Effective

Satisfactory initial correction was achieved in 95% of idiopathic clubfeet, regardless of method, however, maintenance of the correction was challenging as relapses occurred in 37% of feet treated by the Ponseti method and 29% of Feet treated byThe French functional method.

Treatment of idiopathic clubfoot: an historical review.

The aim of this review is to assess the different methods of clubfoot treatment used over the years in light of an evolving understanding of the pathoanatomy of the deformity, but to also clarify factors that allow a safe, logical approach to clubfoot management.

Comparison of surgeon and physiotherapist-directed Ponseti treatment of idiopathic clubfoot.

In this institution, the Ponseti method of cast treatment of idiopathic clubfeet was as effective when it was directed by a physiotherapist as it was when it is directed by an orthopaedic surgeon, with fewer recurrences and a less frequent need for additional procedures in the physiotherapy-directed group.

A comparison of two nonoperative methods of idiopathic clubfoot correction: the Ponseti method and the French functional (physiotherapy) method.

Nonoperative correction of an idiopathic clubfoot deformity can be maintained over time in most patients and there was a trend showing improved results with use of the Ponseti method, but the difference was not significant.