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

Abstract

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.

Can Selective Soft Tissue Release and Cuboid Osteotomy Correct Neglected Clubfoot?

“…Despite widespread worldwide use of the Ponseti method through targeted national programs [28,36,38,40,42], patients with neglected clubfeet still present for evaluation because of limited access to treatment facilities and lack of awareness that treatment options are available [19,28,37]. In many low-income countries, patients with congenital clubfeet present to the physician late, when parents become concerned about their children starting to walk on the deformed feet.…”

“…If the foot is not corrected by walking age, the effect of weightbearing worsens the equinus and varus deformities, making the clubfoot nonreducible [37]. Eventually, the lateral column of the foot (calcaneus plus cuboid) elongates more than the medial one (talus, navicular, and cuneiform) and renders the deformity stiff [28,38]. Severe neglected clubfoot is associated with pain and difficulty in locomotion; moreover, recurrent skin breakdown with infections is observed, which sometimes can lead to amputation, especially in patients who are unable to wear shoes [37].…”

Pé torto congênito

“…93,94,106 Figure 2 illustrates a case treated by the Ponseti method. The Ponseti method is being widely publicized, both in developed countries and in those under development [107][108][109][110][111][112] , on account of the good correction rates achieved, which are close to 90% 4,60,95,113,114 , while in Kite's technique, around 50% of cases require surgical intervention and around 40% present residual deformity. 115 Another important factor is that the treatment time with Kite's technique is approximately twenty-two months, while with the Ponseti method, the time is from two to four months.…”

Perceptions Regarding Medical Management of Clubfoot in Kenya

“…In Africa, for example Malawi, the prevalence of clubfoot is approximated to be 2 to 3 per 1000 live births (Tindall, Steinlechner, Lavy, Mannion & Mkandawire, 2005) while in Uganda the prevalence of clubfoot is estimated to be at 1.2 per 1000 live birth (Pirani et al, 2009). …”

“…In developed and developing countries, disability in childhood remains a challenge (Pirani et al, 2009). Linked to this disability is increase in the prevalence of infants born with congenital clubfoot (Matthew, Dobbs, Nunley & Shoenecker, 2006).…”