Clubfoot - no clear cause, but possibly a cure

Tens of thousands of babies worldwide are still born with clubfoot - feet turned inward at birth - despite a cost-effective, non-surgical treatment, say health experts.



About 150,000 children are born every year with the deformity that, if left untreated, increases in severity and pain, leading to a life of stigma, isolation, disability and depression, said Canada-based Shafique Pirani.



Named after its inventor, the Ponseti method means even people not trained as doctors can treat clubfoot through corrective foot manipulation and castings, followed by corrective shoe braces made by trained cobblers for as little as US$4.



"It [clubfoot] stops children from following life's normal trajectory. In developing nations, children with neglected clubfoot face great practical difficulties and are often stigmatized. As a result, many do not attend school and cannot find work or a marriage partner," said Pirani.



Clubfoot is the most common and serious birth defect of the muscular skeletal system, said Pirani. "It has been a scourge on civilization for thousands of years, but until the Ponseti technique began to be practised in the 1990s, the only cure was expensive, corrective surgery."



Ignacio Ponseti of the University of Iowa developed the non-surgical intervention in 1963, but only decades later did his research catch on in the United States, Canada and the UK, said Pirani.



Norgrove Penny, a senior adviser for physical impairment at the German NGO CBM International, said the treatment's success rate exceeded 90 percent in the developing countries the organization had studied. "This is a very effective method for preventing disability and major surgery in babies."



Clubfoot prevalence is highest in the Polynesian Islands, where it occurs in seven out of 1,000 births, and is lowest among more homogenous Asian populations - 0.57 out of 1,000 births, according to a study by Tel Aviv University



"The reasons for the higher prevalence are uncertain - it could be a genetic influence," said Pirani.



Extensive international research has not yet revealed a cause.



Bangladesh



For years after his birth, Arafat Faiaz's mother tried unsuccessfully to cure his clubfoot with regular oil massages.



"Walking is painful and finding work is difficult," said Faiaz, now 35.



When Faiaz's own baby was diagnosed with clubfoot, he attended a free Ponseti clinic in Dhaka offered by the Walk for Life Bangladesh Sustainable Foot Programme, established by Australia-based NGO, the Glencoe Foundation.



The programme has treated more than 2,400 infants since it began in 2009 and aims to make the Ponseti method available to every club-footed infant in Bangladesh by the next decade.



Colin McFarlane, founder of the Glencoe Foundation, told IRIN an estimated 5,000 babies are born with clubfoot each year in Bangladesh.



Obstacles



The lack of medical supplies such as plaster and braces remains an obstacle, said UK-based orthopaedic surgeon Steve Mannion, who has set up pilot clubfoot treatment programmes in Malawi, Sudan, Ethiopia, Sierra Leone, Cambodia, Laos, Vietnam and Papua New Guinea.



Another is poor access to the treatment in rural areas.



Mannion set up Malawi's first national clubfoot treatment programme in 2002. "The method was also very applicable to Africa, where orthopaedic surgeons are scarce - there were only three for the Malawian population of 12 million in 2000, and 40 for the whole East African population of 200 million. I saw the potential to eradicate the profound disability of neglected clubfoot deformity."



However, Mannion said that the Ponseti method had only limited success in cases of "neglected" clubfoot - in children over the age of two - and that in less developed nations, these overlooked cases far outnumber those who receive early treatment.



"The resulting disability is profound," he said.



But, said Pirani, "I remain confident that we can become a clubfoot-free world in the next few decades."



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