Neglected clubfoot is common, disabling, and contributes to poverty in developing nations. The Ponseti clubfoot treatment has high efficacy in correcting the clubfoot deformity in ideal conditions but is demanding on parents and on developing nations' healthcare systems.

The neglected clubfoot deformity is a major disabler of children and adults in developing nations. The bones and joints of the foot deform into fixed equinus, adductus, cavus, and supination as patients walk on the side or dorsum of the foot. There is severe obliquity of the calcaneocuboid joint, which must be corrected in most cases. An algorithmic surgical approach, using peritalar soft tissue release and selected midfoot osteotomies, corrects most deformities. In severe cases, a specific form of modified Lambrinudi triple arthrodesis is required, excising large bone wedges from the anterior process of the calcaneus. The Ponseti method of serial casting is proving applicable to developing countries in reducing the burden of disability. In developing nations, combining surgical outreach with existing community-based rehabilitation programs will improve outcomes.

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Untreated clubfoot has been acknowledged as a public health problem in low-income countries. In 2007-2009, a 10-country initiative was implemented by a collaboration of nongovernmental organizations and Ministries of Health to establish and strengthen national programmes for management of clubfoot using the Ponseti technique. Independent evaluation used quantitative data on programme outcomes and qualitative data from service providers and users. Overall, 110 clubfoot clinics were established, 634 practitioners were trained and 7705 children were enrolled for treatment. The public health model of establishing services for clubfoot on a national level was found to be successful in the majority of countries included.

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