Walk for life ‐ the National Clubfoot Project of Bangladesh: the four‐year outcomes of 150 congenital clubfoot cases following Ponseti method

Abstract

BackgroundCongenital clubfoot deformity can cause significant disability, and if left untreated, may further impoverish those in developing countries, like Bangladesh. The Ponseti method has been strategically introduced in Bangladesh by a non-government organisation, Walk For Life (WFL). WFL has provided free treatment for over 17,500 Bangladeshi children with clubfeet since 2009, sustained by local ownership, and international support. This study assesses the 4-year results in children for whom treatment began before the age of 3 years.MethodsA centrally located WFL clinic at Mymensingh Medical College Hospital (MMCH), representative of the larger WFL clinics, which treats >100 cases annually, was reviewed. In 2015, 99 of the 147 eligible subjects who had begun treatment in 2011 were available for follow up. Specific assessment tools enabled evaluation of parent satisfaction, gait function, and relapse cases.ResultsResults for 99/147 cases were returned after four years: 72 males, 27 females. Typical clubfeet comprised 98/99 of cases, and 55/99 were bilateral. The tenotomy rate was 80 %. Brace use after 3 months was 90 %, at 12 months was 65 %, and at 4 years post treatment was 40 %. Functionally, 98/99 of children could walk and run (99 %). Relapsing deformity was found in 13 %. Relapse severity varied: eight were flexible and partial, five were rigid. Half of the children lost to follow were due to changed phone numbers. While parents were very happy with their child’s feet (97 %), a materials cost of 3000 Taka ($US40) was deemed unaffordable by 60 %.ConclusionsThe 4-year outcomes after Ponseti treatment for clubfoot deformity, showed that 99 % of children available for follow up, were walking independently. The relapse rate was low. Parent satisfaction was high, but those whose children required further treatment were less satisfied.

Outcome of Clubfoot Correction at ‘Walk for Life’ Clinic of Mymensingh Medical College Hospital: A Four Year Review

“…27 Further, Evans et al, found 97% parents were happy with their children's improvement with treatment, where as Rahman et al, found that half of parents were highly satisfied after receiving treatment for their child's clubfoot deformity. 10,22 The positive effect of public awareness effortshas been apparent across WFL clinics in Bangladesh, as the age of presentation of children has reduced. Most children reviewed were aged between three and six years.…”

“…9 As reported previously, treatment is generally unaffordable for the families. 10 Since the inception of 'Walk for Life' at Mymensingh Medical College Hospital (MMCH) in 2011, 634 children were treated with Ponseti method, to end 2014. Ponseti method has become the 'gold standard' of care for the treatment of CTEVand has been well circulated all over the world, especially the developing world where most clubfoot children live.…”

‘Fast cast’ and ‘needle Tenotomy’ protocols with the Ponseti method to improve clubfoot management in Bangladesh

“…The parents’ preference for more frequent cast changes was expressed to treating clinicians, and specifically, parents reportedly liked visualising and washing their child’s foot and leg at shortened intervals. Whilst the number of casts and associated clinic visits for the corrective casting still averaged five, the shortened treatment phase may reduce the likelihood of treatment being interrupted, which has previously been reported as a factor reducing parental satisfaction [ 21 ].…”

Comparison of different conservative treatments for idiopathic clubfoot: Ponseti’s versus non-Ponseti’s methods

“…Two independent reviewers assessed the eligibility of the studies by reviewing the titles and abstracts. The inclusion criteria were as follows: 1 conservative treatment of patients with clubfoot, 2 comparison between Ponseti’s method and at least one non-Ponseti’s method, 3 publication in English, 4 and enough data to calculate the odds ratio (OR) and 95% confidence interval (CI). The exclusion criteria were as follows: 1 similar studies including the same patients and 2 lack of comparison between those similar studies.…”

“…1 Treatments involving splints, physical therapy, and corrective casts have been widely used, but these conservative treatments have been replaced by surgical operations such as soft tissue release during the past several decades. 2 , 3 For many years, extensive and complex operations were the major management techniques for clubfoot, but the long-term results were not excellent, 2 , 3 and surgical release procedures were used to lengthen the tight soft tissues on the medial and posterior aspects of the clubfoot. 4 Excellent results were not achieved until Ponseti introduced a novel casting method with which to correct the forefoot adduction, hindfoot varus, equinus, and cavus in patients with clubfoot.…”