The Mozambique Clubfoot Program, was established in the country in 2013, as a partnership between CURE International, the Ministry of Health and MIHER with the following main objectives: (1) create conditions in health facilities for effective treatment, accessible and appropriate for all children born with Clubfoot; (2) provide training for health professionals and community health workers so that cases of Clubfoot in young children, are identified and treated appropriately, with a vision of eliminating Clubfoot as a cause of permanent disability in Mozambique.
Clubfoot is one of the most common congenital physical disabilities worldwide, known to occur in 1-3 of every 1,000 births worldwide with evidence of higher rates in developing nations. For the vast majority of cases there is no known cause, although genetic and environmental causes appear to be linked. Millions of adults in Africa have been permanently disabled with clubfoot because early, quality treatment was not available to them as children.
Clubfoot can be easily and inexpensively corrected if treated within the first two years of life. A child born with clubfoot in developed countries will have this condition addressed before he or she can even take their first steps. For children in developing nations with limited to no access to medical care, this condition grows more painful and debilitating over time as the child is forced to walk on their ankles. Those with neglected clubfoot also suffer social stigma – they are commonly mocked, ignored, or isolated from the family and community in which they live. Once the child reaches adulthood, the opportunity to correct the condition without extensive, expensive, and painful surgery is lost.
CURE’s vision is to build capacity for clubfoot treatment within developing countries, establishing national clubfoot treatment programs. The ultimate goal is for early treatment to be accessible for every child born with clubfoot in those countries, such that clubfoot will be eliminated as a permanent disability. It is anticipated that elimination of the disability will in turn significantly impact the areas of livelihoods, health, education, social inclusion and empowerment at individual, family and community levels.
The Ponseti Method for clubfoot treatment is accepted by the World Health Organization (WHO), the American Academy of Pediatrics and American Academy of Orthopedic Surgeons as the standard for clubfoot treatment. It is evidence based, with a 90 – 95% success rate demonstrated through longitudinal research conducted over 50 years at the University of Iowa. It has also been shown to have less severe reoccurrence when compared to surgical interventions.3 In a recent survey of clubfoot treatment in the USA, parents identified the Ponseti Method as their preferred treatment option.
The Ponseti Method uses a series of plaster casts over 4 – 6 weeks to correct the deformity, immediately followed by use of foot abduction braces, worn 23 hours per day for 3 months and then worn only at night for up to 4 years, to prevent recurrence. Some children may require a small cut to the tendon at the back of the heel prior to the final cast being applied, done using local anesthetic. This method is ideally suited for the developing world because it is inexpensive and can be performed by trained paramedical staff in addition to doctors.
Dr. Bernabé Deausse gives a overview of Mozambique Clubfoot Program (video in Portuguese).