Presented to the World Health Organization's 'GATE' initiative consensus workshop, this brief paper outlines an investment case for orthotic management of club feet in health packages and rehabilitation measures.

1. CLUB FOOT (CTEV) BRACING
CONSIDERATION FOR THE CONSENSUS GROUP
Products for Special consideration in the Priority Assistive Product List
Dr. Wes Pryor
With Phoebe Thompson
B.Prosth Orth, Senior Prosthetist Orthotist, Royal Children’s Hospital, Melbourne

2. ONE OF
DISABLINGMUSCULOSKELETAL CONDITIONS
IF LEFT UNTREATED
THE MOST

3. Incidence: ~1 – 7 per 100,000 births (http://globalclubfoot.com)
Higher incidence in some ethnic groups
(i.e. Polynesian, Melanesian, South Asian)
Higher incidence in countries with less individual income & capacity to pay
Globally ~200,000 per year
Best practice treatment effective in up to 95% of cases
Current unmet need = ?
Estimated 1,000,000 people living with untreated clubfoot

4. Adapted from miraclefeet.org
birth
Early ID
Start
casting
23/24
bracing
3 months
Night
bracing
Tenotomy
~85% of cases
3-4 years
Fully
treated
1-2 weeks 5-7 weeks
Orthotic
management
If no bracing,
..no point casting.
“
“

5. Avoidable impairment
& lost participation
Surgery  stiffer and less functional feet
birth
Early ID
Start
casting
23/24
bracing
3 months
Night
bracing
Tenotomy
~85% of cases
3-4 years1-2 weeks 5-7 weeks
Recurrence risk if no bracing
…Relapse occurs in more than 80% of
cases. This is in contrast to a relapse rate
of only 6% in compliant families
(Morcuende et al., 2004)
“
“

6. http://blog.mendeley.com/2014/09/11/crowdfunding-brings-clubfoot-treatment-to-children-in-the-developing-world/

7. Low-cost: $349 Ponsetti vs $810 for surgery,
Costs of bracing restrictive for families (Pakistan study)
(Hamidah et al., ‘14)
Significant cost and risk of complex reconstructive
surgery (Halanski et al., 2009)
3-fold increase in cost with recurrence
(Halanski et al., 2009)
Most common surgical congenital
anomaly (Kenya) (Wu et al., ‘13)
“

8. Correct foot position achieved through casting
Brace must hold foot in corrected position
Sustainable, reusable, easy to manufacture
Or low cost, easily accessible, pre-fabricated.
Education to family & community
Ongoing professional reviews (up to ~ 4years old)
$10-$600 range, ~5 devices during treatment
BRACINGCONSIDERATIONS

9. Prevalence, inequities and impact of treatment
Strong evidence of effectiveness (and implications of non-treatment)
Effective avoidance of impairment and lost quality
of life
Low-cost, & offsets other costs (i.e. effectively a negative cost)
A case for prioritisation of clubfoot bracing

10. © Copyright The University of Melbourne 2008