Introduction To Clubfoot

Dr. E KOMBO

What is clubfoot?

• ‘Congenital deformity of the foot that feels fixed’

• Congenital Talipes Equinovarus (CTEV)

Clubfoot Etiology

• Most often idiopathic• Less commonly

secondary• Not understood clearly• Definite hereditary

influence– NOT related to mother’s

behaviour

Epidemiology

• Incidence – Incidence – 0.6-8/1000 live births (average 1.2/1000)

• Prevalence – higher in low and middle income countries

• Global epidemiology – approximately 200,000 new cases per year, 80% in low and middle income countries.

• More common in boys: 2:1 male: female• 40% of cases bilateral

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Worldwide: 200,000+

Annual Newborns with Clubfoot

Consequences of clubfoot• Idiopathic clubfoot: most

common congenital orthopaedic condition causing locomotor disability.

• Neglected clubfoot results in severe disability and stigma

• As the foot is walked on the deformity worsens

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Consequences of untreated clubfoot

• Cosmetic - permanent deformity

• Pain• Inability to wear normal

footwear• Stigma and discrimination

– difficulty in access– difficulty in gaining

education/employment– Less likely to marry

• Other social consequences - abandonment, begging

• Consequences for the individual, their family and society

Why so much neglected clubfoot?

• Lack of awareness• Condition not

diagnosed / treated early• Lack of treatment

facilities• Ineffective treatment

Clubfoot in [country]

• Number of children born per year with clubfoot: [###]

• Group discussion and feedback:– What methods of treatment are currently being

used for clubfoot in this country?– How well are these working?– What are the challenges of providing treatment for

clubfoot in this country?

Clubfoot treatment options

• Surgical techniques

• Conservative techniques – Kite, French methods

• Other – Ilizarov frames, Thomas wrench

• Ponseti technique

Treatment options: Ponseti technique

• The Ponseti technique: Dr Ponseti (1960s): – A very specific treatment protocol of:– manipulation, casting, tenotomy and bracing.

• ‘Gold Standard’ for clubfoot treatment

• Using the Ponseti technique we have the opportunity to prevent disability and change a child’s life!

Clubfoot treatment: public health perspective

• Easy• Efficient• Effective• Economical

CURE Clubfoot Worldwide (CCW)• Part of CURE International, paediatric orthopaedic non-profit

organisation

• Has programmes for clubfoot in 16 countries worldwide (2011)

• CCW works to establish and support national programmes for clubfoot:– Train local health workers in Ponseti management– Raise awareness about clubfoot– Provide funding for children who cannot afford treatment

A national programme for clubfoot in [country]

• [Add details here of the national clubfoot, partner organisations including CCW etc]

• Today YOU are part of a national and international programme to make the lives of children with clubfoot better!

• Web-based group for sharing resources and training materials for organisations and individuals working with children with clubfoot in low and middle income countries

• www.globalclubfoot.org

• Collaborative partnership between organisations• CURE Clubfoot Worldwide, ALTSO, CBM International,

Feetfirst, Handicap International, Prosthetics Outreach Foundation, Walk for Life and many more

Acknowledgements• Development of these training materials was funded by CURE Clubfoot Worldwide

and we thank everyone involved especially those who volunteered their time and resources to help.

• Andy Mayo (CURE Clubfoot Worldwide, Miraclefeet) - for starting it all off• Jim Cohick (CURE Clubfoot Worldwide) – for coordinating the project• Rosalind Owen (Global Clubfoot Initiative) and Dr Norgrove Penny (CBM

International) – for editing the materials

• Reviewers:• Dr Bob Cady (USA, Haiti)• Dr Fred Dietz (USA, Bangladesh, Laos)• Linda Hansen (Australia, Kenya)• Professor Chris Lavy (UK, Malawi)• Iris Lohan (China)• Dr Norgrove Penny (Canada, Uganda)• Michiel Steenbeek (Netherlands, Uganda)

We would like to acknowledge the people who contributed material and images for this curriculum:

Winfried DankeNaomi Davis MB BChFred Dietz MDMatthew Dobbs MDVikas Gupta MDJohn Herzenberg MDChris Lavy MDIris LohanColin MacFarlaneSteve Mannion MB, BChJennifer McCahillJosé Morcuende MD

Vince Mosca MDMonica Noguiera MDRosalind OwenNorgrove Penny MDShafique Pirani MDIgnacio Ponseti MDDavid Scher MDMarc Sinclair MDDavid Spiegel MDLynn Staheli MDMichiel Steenbeek