SEATTLE, Washington — Worldwide, roughly 150,000 to 200,000 babies are born with clubfoot annually and about 90% of these births occur in developing nations. According to Boston Children’s Hospital, “clubfoot is a congenital foot deformity that affects a child’s bones, muscles, tendons and blood vessels. The front half of an affected foot turns inward and the heel points down. In severe cases, the foot [turns]so far that the bottom faces sideways or up rather than down.” To this day, doctors and medical professionals do not know the cause of this common congenital birth defect and cannot pinpoint proper pre-birth prevention protocols. Despite developing countries holding 90% of the burden of clubfoot cases, these nations “[receive]only 10% of the health care funding to treat it.” Without treatment, clubfoot can lead to immobility, significantly affecting a child’s quality of life.
A Closer Look at Clubfoot
Although there is no identified cause of clubfoot, experts suspect that the deformity may be hereditary. If a mother has a child with clubfoot, the next child is 4% more likely to be born with it. The odds balloon to 15% if both parents are born with clubfoot. The symptoms of the deformity vary and include one or both feet turned toward one another, along with rare cases of the clubfoot twisting bottom-side up. Alongside the abnormalities, feet, heels and calf muscles may be small or underdeveloped, which can impede upright balance. Doctors can only diagnose clubfoot after birth and the condition has a chance of forming in any developing baby.
Possible Treatment for Clubfoot Cases
Clubfoot treatment typically follows two existing routes: surgery or the Ponseti method. The Ponseti method is a non-surgical procedure typically performed on children younger than the age of 2. The Ponseti method has two phases; the treatment phase entails placing different corrective casts over a multiple-month timespan until the child’s feet reach a specific correction milestone. Next, a medical professional makes a small incision on the top of the heel to lengthen the Achilles tendon. The second stage is the maintenance phase where the child wears foot braces designed to prevent symptoms from reoccurring. The child wears the braces until about 5 years of age, depending on recovery speed.
Surgical intervention is suitable for a child older than 2. After general anesthesia, a surgeon makes one or two cuts in the back of the foot and adjusts any tendons that prohibit healthy foot growth. The Achilles tendon is the most common culprit when it comes to clubfoot deformities. A surgeon either extends or cuts the tendons to normalize the foot position. If deformities still persist, children may require additional bone removal.
How Clubfoot Breeds Poverty
A 2018 research study analyzed several existing studies to determine the “factors that impact on the successful implementation of clubfoot treatment services” in developing countries. Across the board, researchers identified the main challenge as “a lack of access to [health care]resources.” Other factors include inadequate working spaces for clinicians, inadequate numbers of health care professionals and a lack of training for efficiently treating clubfoot.
In an interview with The Borgen Project, Steve Robinson, marketing and communications specialist for Hope Walks, says that “left untreated, clubfoot makes walking difficult or impossible for these kids.” As they grow into adults, society shuns them, pushing many toward a life of begging on the streets. He says further that estimates indicate that every child receiving a clubfoot correction has “an additional $120,000 in earning potential over their lifetime.” The most populated country in Africa, Nigeria, has around 9,433 new cases of clubfoot a year. But, without treatment, the likelihood of a good quality of life is stripped away from these young children.
Hope Walks is a Christian organization that developed in 2019 from the already existing clubfoot program with CURE International in 2006. “[Hope Walk’s] mission is to treat kids with clubfoot in Latin America and Africa,” Robinson says. The organization currently operates in 16 countries.
Hope Walks provides training on the Ponseti method to existing health care staff in clinics and hospitals in Latin American and African countries. The organization sees the Ponseti method as “the gold standard of clubfoot treatment,” critical to preventing the further impoverishment of children in developing nations.
Despite the impact of the COVID-19 pandemic and a mass shutdown of clinics, Hope Walks was “able to enroll 14% more children [in its treatment programs]in FY21 than in FY20. Noting an enrolment of 6,400 children in 2021, the organization aims to increase enrolments to 7,500 in time to come.
Robinson adds, “We often hear about the struggles our families have affording the transportation fares to get to clinics. A generous donor has allowed us to establish a transportation grant that our staff can use at their discretion when they hear a family can’t afford to come to a clinic visit.” Robinson notes that adherence to the treatment process and time periods is critical for clubfoot treatment to see success. He explains that “corrected feet can easily relapse to their twisted state” if children miss “casting and bracing appointments.”
Avoiding the Grips of Poverty
Hope Walks recognizes that, without treatment, a child “will be unable to walk,” a factor that can push the child into the clutches of poverty. With basic casts and braces, this deformity can be successfully treated. However, without the necessary resources and training for health care staff, this simple treatment is not possible. On its website, Hope Walks appeals to donors for support, leaving them with some food for thought: “A few hundred dollars means the difference between a life begging on the streets and a life of hope.”
– Fidelia Gavrilenko