Reduce cases of clubfoot in poor countries

SEATTLE, Wash. – Worldwide, about 150,000 to 200,000 babies are born with clubfoot each year, and about 90 percent of those births occur in developing countries. According to Boston Children’s Hospital, “Clubfoot is a birth defect of the foot that affects a child’s bones, muscles, tendons, and blood vessels. The front half of an affected foot turns inward and the heel points downward. In severe cases, the foot [turns]so far that the bottom faces sideways or up rather than down. To date, doctors and healthcare professionals do not know the cause of this common birth defect and cannot identify appropriate prenatal prevention protocols. Although developing countries hold 90% of the burden of clubfoot cases, these countries”[receive]only 10% of health care funding to treat it. Without treatment, clubfoot can lead to immobility, significantly affecting a child’s quality of life.

A closer look at clubfoot

Although there is no identified cause of clubfoot, experts suspect that the deformity may be hereditary. If a mother has a child with clubfoot, the next child is 4% more likely to be born with it. The odds go up to 15% if both parents were born with clubfoot. Symptoms of the deformity vary and include one or both feet turning towards each other, as well as rare cases of downward twisting of the clubfoot. Along with abnormalities, the feet, heels, and calf muscles may be small or underdeveloped, which can impede vertical balance. Doctors can only diagnose clubfoot after birth, and the condition has a chance of forming in any developing baby.

Possible treatment of clubfoot cases

The treatment of clubfoot generally follows two existing paths: surgery or the Ponseti method. The Ponseti method is a non-surgical procedure usually performed on children under 2 years old. The Ponseti method has two phases; the treatment phase involves placing different corrective casts over a period of months until the child’s feet reach a specific correction milestone. Next, a healthcare professional makes a small incision on the top of the heel to lengthen the Achilles tendon. The second stage is the maintenance phase where the child wears foot orthoses designed to prevent the recurrence of symptoms. The child wears the device until about 5 years old, depending on the speed of recovery.

Surgical intervention is suitable for a child over 2 years old. After general anesthesia, a surgeon makes one or two incisions in the back of the foot and adjusts the tendons that prevent healthy foot growth. The Achilles tendon is the most common culprit when it comes to clubfoot deformities. A surgeon stretches or cuts the tendons to normalize the position of the foot. If deformities persist, children may need additional bone removal.

How clubfoot causes poverty

A 2018 research study analyzed several existing studies to determine “factors that impact the successful implementation of clubfoot treatment services” in developing countries. Overall, the researchers identified the main challenge as “a lack of access to [health care]Resources.” Other factors include inadequate workspaces for clinicians, an insufficient number of medical professionals and a lack of training to effectively treat clubfoot.

In an interview with The Borgen Project, Steve Robinson, marketing and communications specialist for Hope Walks, said that “without treatment, clubfoot makes walking difficult or impossible for these children”. As they become adults, society shuns them, pushing many towards a life of begging on the streets. He further says that estimates indicate that each child receiving clubfoot correction has “an additional lifetime earning potential of $120,000.” Africa’s most populous country, Nigeria, has about 9,433 new cases of clubfoot per year. But, without treatment, the likelihood of a good quality of life is taken away from these young children.

walks of hope

Hope Walks is a Christian organization that grew in 2019 from the already existing clubfoot program with CURE International in 2006.”[Hope Walk’s] mission is to treat children with clubfoot in Latin America and Africa,” says Robinson. The organization currently operates in 16 countries.

Hope Walks offers training on the Ponseti method to existing health personnel in clinics and hospitals in Latin American and African countries. The organization considers the Ponseti method to be “the gold standard of treatment for clubfoot”, essential for preventing child impoverishment in developing countries.

Despite the impact of the COVID-19 pandemic and the massive closure of clinics, Hope Walks has “been able to enroll 14% more children [in its treatment programs]in FY21 than in FY20. Noting an enrollment of 6,400 children in 2021, the organization aims to increase enrollment to 7,500 in the coming years.

Robinson adds, “We often hear about the difficulties our families have in paying the transport costs to get to the clinics. A generous donor allowed us to establish a transportation grant that our staff can use at their discretion when they learn that a family cannot afford to travel to a clinic visit. Robinson notes that following the treatment process and time frames is essential for successful clubfoot treatment. He explains that “corrected feet can easily fall back into their twisted state” if children miss “casting and splinting appointments.”

Avoid the clutches of poverty

Hope Walks recognizes that without treatment a child “will be unable to walk”, a factor which can push the child into the clutches of poverty. With basic casts and braces, this deformity can be successfully treated. However, without the necessary resources and training for caregivers, this simple treatment is not possible. On its website, Hope Walks calls on donors to support them, leaving them with food for thought: “A few hundred dollars makes the difference between a life of street begging and a life of hope.

– Fidelia Gavrilenko
Photo: Flickr

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