Congenital clubfoot is common and affects children around the world. It is estimated that over 100,000 babies are born each year worldwide with clubfoot. For those children affected either one or both feet are twisted in such a manner that if left untreated the child walks on the outside of their feet causing pain and lifelong disability.
Treatment of clubfoot with surgery, unfortunately, can also result in long-term foot pain, arthritis, and a poor quality of life.
The Ponseti method is a non-invasive technique to correct clubfoot that relies on gentle manipulation of the foot followed by casting. Over a period of several months the clubfoot is fully corrected with this method and the correction is then maintained with bracing for several years. Success rate with this method is reported as high as 98% and allows treated patients to live a normal life free of foot pain.
Despite the clear advantages of the Ponseti method, it requires extensive training to master and the upmost attention to detail in implementation which has limited worldwide availability of properly trained Ponseti providers. This is a significant problem in much of the developing world where most clubfoot patients have no access to treatment at all. Even in the United States where the Ponseti method has become the gold standard, there are still many patients that don’t have access to a Ponseti trained provider or experience relapse after initial successful treatment and then undergo more invasive surgical treatment.
There is an urgent need to develop clubfoot training centers not only in the United States but around the world. It is also essential to provide forums for clubfoot treatment providers to present the latest research and advance the field. The 9th International clubfoot congress, an example of one such forum was held this month in Montreal, Canada. This Congress brought together over 80 Ponseti doctors from 24 different countries. A central message was while the Ponseti method has gained acceptance in many countries there is much work to be done to eradicate clubfoot disability worldwide.
Clubfoot parents and families have provided a key driving force helping to spread word of the benefits of the Ponseti method over surgery. Parents through social media and support groups connect with another and help one another through the difficulties of the lengthy treatment process.
World Clubfoot Day is celebrated is celebrated June 3rd every year, Dr. Ponseti’s birthday and is a day in which physicians, families, and patients celebrate the life of Dr. Ponseti and his contributions to helping clubfoot patients lead normal lives.
While the Ponseti method is effective, it is challenging for patients, their families, as well as Ponseti providers. Treatment with bracing goes on for 4 to 5 years after casting and this phase of treatment due to its length is particularly burdensome and costly.
There is a tremendous need for research dollars invested in the search for the cause of clubfoot and in the development novel treatment and prevention strategies.
The public needs to be aware of the worldwide burden of clubfoot and the importance of access for every clubfoot child to have proper treatment.
The vision of world without clubfoot disability will only happen with the concerted efforts of all stakeholders including funding agencies, clubfoot families, and Ponseti providers.
Pediatric Orthopaedic Society of North America
Shriners Hospital for Children