Clubfoot occurs when a baby’s tendons are shorter than usual, positioning the foot at a sharp angle to the ankle, like the head of a golf club. Because 80 percent of the 200,000 children born with clubfoot each year are in low or middle income countries, many do not receive treatment, resulting in a disability that affects their mobility and quality of life. Learn how the low-cost, low-tech Ponseti method can prevent long-term disabilities and how Rotarians can help improve access to treatment. Moderator: Thomas Cook, Rotary Club of Iowa City, Iowa, USA

1. Monica Nogueira
Ponseti International
4420 – Sudeste Brazil
How Rotarians can help
erradicate disability from clubfoot

2. Congenital
Talipes
Equino-
Varus

3. Muscle & tendon
imbalance in the lower leg
leading to skeletal
deformity in the foot-ankle.
NOT due to:
Fetal
positioning
Lunar eclipse
Ancestral curse
Birth control
pills
Poor nutrition
Polio
Witchcraft
Twin births, etc.

4. • Approximately 1 in every 750 live births
• Twice as common in males as in females
• Occurs in both feet half of the time
• 200,000 clubfoot children born annually
• 100,000’s of “neglected” cases (~1 Million)
• No social or economic influences

7. Never married, depend on government help for living
problem

8. An 8 year old Nigerian boy
with primary neglected
clubfoot.
Abandoned to live with his
grandmother.
Discovered crawling around
in a rural village by medical
students on an outreach visit.
RILWAN

9. OTAVIO, 7 year old boy from Peixe Boi – PA , Brazil
Did not go to school
Because colleagues called
him
“crippled” and other names

10. The PONSETI METHOD
• Gentle manipulation and stretching
• Series of precisely applied plaster casts
• Percutaneous tenotomy (most cases)
• Wear brace while sleeping to age four
Ignacio V. Ponseti
(1914-2009)

11.  The Ponseti Method is unquestionably the “Gold
Standard” for correcting clubfoot deformity.
 Bracing is critical for maintaining the correction.

12.  Costs of current “state-of-the-art” clubfoot braces range
from $500 per year to more than $2,500.
 These braces are used almost exclusively in higher-income
countries.
 In low-resource countries, most braces:
– Are made using low-quality, locally available materials.
– Lack important design features.
– Often cause skin problems and disuse, resulting in
return of the deformity.

13. Ponseti
Method

14. Partner with/support clubs in low-resource areas:
• Help form the Rotarian Action Group and recruit Rotarians around the world
to band together.
• Support training of local health professionals.
• Assist families and caregivers with logistical support, including
transportation, housing, food, and other needs.
• Assist families with the provision of night-time braces to complete Ponseti
treatment.
• Assist with public awareness to reduce the stigma, to spread the message
that “Clubfoot is treatable”, and to promote early referral to appropriate
treatment centers.
• Advocate with governments and health officials to provide the facilities and
resources to treat clubfoot deformity.

15. •Help form the Rotarian Action Group and
recruit Rotarians around the world to work
together.

16. Support training of local health professionals

17. Assist families and caregivers with logistical support,
including transportation and housing

18. Support bracing to complete treatment

19. Raise Public
Awareness

20. THE UGANDA CLUBFOOT PROJECT
The Children’s Orthopaedic Rehabilitation Project, The Rotary Foundation, Canadian
International Development Agency , Ugandan Ministry of Health, Makerere University
Medical School Department of Orthopaedics
A 4 Year Rotary project to enable Ugandan healthcare
professionals to treat Ugandan children with clubfeet
All children in Uganda born with
Clubfeet will
• be identified at birth
• have access to Ponseti treatment

21. Guatemala
• Starting in 2010, 7 clubs in Districts
5970 & 6000 raised $25,000.
• Partnered with Club Rotario La
Ermita in Guatemala City.
• In-country workshop for 15 MDs.
• In 2012, 3 doctors attended the
International Symposium & had
additional training in Iowa.

22. Workshop on
Clubfoot
Exhibit Booth 65
December 2014

23. RILWAN
Treated with Ponseti
method using five
casts.
Now walks independently
without pain and is enrolled in
school for the first time.
His mother first
came to the clinic
on the day the
last cast was
removed.

24. HOW A CHILD CAN CHANGE...

25. Rotarian Action
Group
RAG4clubfoot
Global support for Awareness, training and Treatment
World free from clubfoot disability
www.RAG4CLUBFOOT.org

26. www.RAG4CLUBFOOT.org
Establishing a Rotarian Action Group
to eliminate clubfoot disability.
Email: info@rag4clubfoot.org
You can sign-up to join the effort to
create RAG4CLUBFOOT by visiting
the website.
Charter District members:
6000, 5970, 5240, 5020, 9640
and 5950