Clubfoot is treatable
BIRTH DEFECT: WHY AREN’T MORE SA FAMILIES ACCESSING CARE?
Lifelong disability can be avoided, says medical expert.
Globally, clubfoot is the most common musculoskeletal birth defect, affecting millions of children worldwide. Despite its prevalence, accessing treatment remains a significant challenge for families in resource-restricted countries like South Africa.
A 2023 study to determine new estimates of the global prevalence of clubfoot, published in The Lancet’s eClinical Medicine, revealed that of 1.18 babies out of 1 000 births are born with clubfoot, and highlighted significant incidence in the Southern Africa region.
A local study published in 2022 in South African Journal of Child Health estimated that 80% of the world’s clubfoot cases occur in lowand middle-income countries.
Steps, a non-profit organisation working across South Africa and neighbouring countries to support families accessing treatment for clubfoot, estimates that prevalence in the region is at least double the global rate.
Karen Moss, founder and CEO of Steps, says: “We operate on the basis that two out of every 1 000 children will be born with clubfoot.
“However, a high rate of this congenital condition is just one aspect of the challenges South Africa faces. Clubfoot is a treatable birth defect. Early intervention can avoid costly surgical treatments.”
What is clubfoot?
Clubfoot develops in the womb and babies born with the condition have one or both feet fixed in a downward and inward position.
Left untreated, a child will not be able to walk properly and will experience chronic pain, muscle wasting in the legs and progressive degeneration of joints.
On the other hand, most families that start prompt treatment using the Ponseti Method, the non-surgical global gold standard, have excellent outcomes.
Lifelong disability can be avoided, Moss says.
“Aside from clubfoot, most patients are healthy babies. Studies have shown that clubfoot is successfully corrected in over 90% of cases using successive plaster casts and maintenance bracing as the baby develops,” she says.
“In most of these cases, children can walk, run, dance, and play as they grow up into able, contributing citizens. Therefore, becoming progressively disabled and living in pain due to clubfoot is completely preventable.
“While we can’t change the prevalence of clubfoot, there’s still so much that we can do to increase access to effective treatment for all South African families.”
In its advocacy for clubfoot treatment, Steps identifies lack of awareness and stigma, as well as lack of access to treatment in local health care facilities. This, as well as economic factors as significant barriers for families.
“Clubfoot treatment requires frequent, time-bound visits to health care facilities to change the casts and monitor progress as the infant grows,” says Moss.
“It’s heartbreaking that so many South African families, particularly in the rural and resource-restricted areas simply don’t have the money to transport their babies to a clinic on a regular basis.”
In 2023, Steps supported 4 703 children with 1 162 new patients enrolled across 40 partner clinics in South Africa. However, this is only around half of the estimated 2 295 new cases annually in South Africa.
The highest number of patients occupying the Steps clinics are in Gauteng, followed by KwaZulu-Natal, and Eastern Cape.
Dr Yammesh Ramguthy, paediatric orthopaedic surgeon at Chris Hani Baragwanath Academic Hospital, and the biggest clubfoot clinic in Southern Africa, says: “The problem is the lack of skilled people to offer the treatment and the support needed thereafter.
“Cost to travel is also a significant factor. It would be much better if families didn’t have to travel across provinces for treatment. I pick up quite a few cases in our clinic that can be, or should have been, managed better.”