2. What is clubfoot?
• ‘Congenital deformity of
the foot that feels fixed’
• Congenital Talipes
Equinovarus (CTEV)
3. Clubfoot Etiology
• Most often idiopathic
• Less commonly
secondary
• Not understood clearly
• Definite hereditary
influence
– NOT related to mother’s
behaviour
4. Epidemiology
• Incidence – Incidence – 0.6-8/1000 live births
(average 1.2/1000)
• Prevalence – higher in low and middle income
countries
• Global epidemiology – approximately 200,000
new cases per year, 80% in low and middle
income countries.
• More common in boys: 2:1 male: female
• 40% of cases bilateral
6. Consequences of clubfoot
• Idiopathic clubfoot: most
common congenital
orthopaedic condition
causing locomotor
disability.
• Neglected clubfoot results
in severe disability and
stigma
• As the foot is walked on
the deformity worsens
7. Consequences of untreated
clubfoot
• Cosmetic - permanent
deformity
• Pain
• Inability to wear normal
footwear
• Stigma and discrimination
– difficulty in access
– difficulty in gaining
education/employment
– Less likely to marry
• Other social
consequences -
abandonment, begging
7
• Consequences for the
individual, their family
and society
8. Why so much neglected clubfoot?
• Lack of awareness
• Condition not diagnosed
/ treated early
• Lack of treatment
facilities
• Ineffective treatment
9. Clubfoot in [country]
• Number of children born per year with
clubfoot: [###]
• Group discussion and feedback:
– What methods of treatment are currently being
used for clubfoot in this country?
– How well are these working?
– What are the challenges of providing treatment
for clubfoot in this country?
10. Clubfoot treatment options
• Surgical techniques
• Conservative
techniques – Kite,
French methods
• Other – Ilizarov frames,
Thomas wrench
• Ponseti technique
11. Treatment options: Ponseti
technique
• The Ponseti technique: Dr Ponseti (1960s):
– A very specific treatment protocol of:
– manipulation, casting, tenotomy and bracing.
• ‘Gold Standard’ for clubfoot treatment
• Using the Ponseti technique we have the
opportunity to prevent disability and change a
child’s life!
13. CURE Clubfoot Worldwide (CCW)
• Part of CURE International, paediatric orthopaedic non-
profit organisation
• Has programmes for clubfoot
in 16 countries worldwide (2011)
• CCW works to establish and support national
programmes for clubfoot:
– Train local health workers in Ponseti management
– Raise awareness about clubfoot
– Provide funding for children who cannot afford treatment
14. A national programme for clubfoot
in [country]
• [Add details here of the national clubfoot, partner
organisations including CCW etc]
• Today YOU are part of a national and
international programme to make the lives of
children with clubfoot better!
15. • Web-based group for sharing resources and training
materials for organisations and individuals working
with children with clubfoot in low and middle income
countries
• www.globalclubfoot.org
• Collaborative partnership between organisations
• CURE Clubfoot Worldwide, ALTSO, CBM International,
Feetfirst, Handicap International, Prosthetics Outreach
Foundation, Walk for Life and many more
16. Acknowledgements
• Development of these training materials was funded by CURE Clubfoot
Worldwide and we thank everyone involved especially those who volunteered
their time and resources to help.
• Andy Mayo (CURE Clubfoot Worldwide, Miraclefeet) - for starting it all off
• Jim Cohick (CURE Clubfoot Worldwide) – for coordinating the project
• Rosalind Owen (Global Clubfoot Initiative) and Dr Norgrove Penny (CBM
International) – for editing the materials
• Reviewers:
• Dr Bob Cady (USA, Haiti)
• Dr Fred Dietz (USA, Bangladesh, Laos)
• Linda Hansen (Australia, Kenya)
• Professor Chris Lavy (UK, Malawi)
• Iris Lohan (China)
• Dr Norgrove Penny (Canada, Uganda)
• Michiel Steenbeek (Netherlands, Uganda)
17. We would like to acknowledge the people who
contributed material and images for this curriculum:
Winfried Danke
Naomi Davis MB BCh
Fred Dietz MD
Matthew Dobbs MD
Vikas Gupta MD
John Herzenberg MD
Chris Lavy MD
Iris Lohan
Colin MacFarlane
Steve Mannion MB, BCh
Jennifer McCahill
José Morcuende MD
Vince Mosca MD
Monica Noguiera MD
Rosalind Owen
Norgrove Penny MD
Shafique Pirani MD
Ignacio Ponseti MD
David Scher MD
Marc Sinclair MD
David Spiegel MD
Lynn Staheli MD
Michiel Steenbeek
