Our aims, for Malawi, Laos and beyond...
Our aims in preventing and correcting clubfoot in Malawi are as follows: Every child born with clubfoot in Malawi should be diagnosed at birth and have access to treatment. An associated course of surgical treatment will also be provided for existing neglected cases
This is being achieved by educating local surgeons and training them to teach the methods used to correct clubfoot and setting up dedicated clubfoot clinics in each district hospital.
Refresher training is given on support visits to district hospitals and research of the condition and data collection is an ongoing process.
Our aims, worldwide...
Our aims are to roll out a worldwide programme for the recognition and management of club foot. We would like every child born with club foot to be diagnosed at birth, and have access to treatment. The Ponseti method is a gold-standard treatment that can easily be applied in the Third World due to its simplicity and cost-effectiveness.
We would also like to provide training for surgeons to manage neglected cases of club foot, and even provide more basic surgical skills training where needed.
In order to do this, we need to educate the local nurses and surgeons, and set up dedicated national screening and management programmes. This needs to be supported by refresher courses and audits to monitor the effectiveness of the education programme.
We currently have on-going projects in Malawi and Laos, and are now starting to focus on Cambodia, the Sudan, Ethiopia and Kazakhstan.
Treatment of club foot
Child with club footClub foot, or "Congenital talipes equino-varus" is the most common significant musculoskeletal congenital abnormality. It is present in 1 in 1000 births in the UK and between 2 & 3 in 1000 births in Africa. In Malawi there are 5000 children with untreated clubfeet, and 500 more are born each year!
One of the ways in which we are battling Club Foot in Malawi, as well as Training programmes and spreading awareness is hands on treatment
Cases presenting in the first year of life can be treated by manipulation and casting by the Ponseti method, which can be done by medical assistants, physios, nurses etc. Children presenting over 1 year of age however, require complex surgery by orthopaedic specialists... of which there are only 5 in Malawi...
The Ponseti Method
Club feetThis method stipulates a specific technique of corrective manipulation followed by plaster immobilisation; thereby avoiding the need for invasive surgery
Ponseti castsCavus, adduction and ankle varus are corrected by weekly manipulation and casting over a period of 5 weeks.
At this stage the only remaining deformity is often equinus for which a percutaneous Achilles tenotomy (“ETA”) is performed followed by a further cast for 3 weeks.
The Colombian Clubfoot Score
Club feet
This method of assessment introduces objectivity into the treatment of clubfoot with six scored (1, 0.5, 0) criteria:
Hindfoot parameters Posterior crease "Empty heel" sign Rigid equinus
Midfoot parameters Medial crease Position of lateral head of talus Curved lateral border of foot
Scores taken at each clinic visit and plotted on a graph, from which response to treatment can be determined
The Steenbeck Foot Abduction Brace (SFAB)
Steenbeck Foot Abduction Brace After correction, clubfoot deformity tends to relapse.
To prevent relapses, after the last plaster cast is removed, a foot abduction brace must be worn full-time for 2 to 3 months and thereafter at night for 2 to 4 years.
The benefits of the Steenbeck Foot abduction brace, which can be use to correct the deformity of Clubfoot are:
- It is a low cost solution
- It can be produced locally using locally available materials - no need to import
- The abduction angle can be varied "Off the peg" sizing
