Clubfoot is one of the most common deformities that babies can be born with. If untreated the child develops a stiff foot in a ‘clubbed’ shape, and has difficulty in walking and participating in everyday life, such as in school and play. Clubfoot is avoidable with early diagnosis and appropriate cost-effective treatment using the Ponseti technique. This minimally invasive technique consists of two distinct phases, (1) the correction phase, with manipulation, casting and often an achilles tendon tenotomy, and (2) the maintenance phase, with use of a foot abduction brace (FAB). Between 2015 and 2018, we sought to find out how services for children with clubfoot in Africa could be improved, and used Zimbabwe as a case study.
 
Our findings are summarised here: https://www.researchgate.net/publication/329360422_Improving_clubfoot_services
 
We found that a health system-oriented approach is needed to improve clubfoot services in Zimbabwe and the wider Africa region. Children with clubfoot can be effectively treated by trained clubfoot therapists (using the Ponseti method) and the majority of children with clubfoot treated in one clinic in Zimbabwe achieve successful short-term and long-term results:
 
1. A comparison of outcome measures used to report clubfoot treatment with the Ponseti method: results from a cohort in Harare, Zimbabwe https://doi.org/10.1186/s12891-018-2365-3
2. Results of clubfoot treatment after manipulation and casting using the Ponseti method: experience in Harare, Zimbabwe https://doi.org/10.1111/tmi.12750
 
To enable this there is a need to ensure that clubfoot clinics are appropriately equipped and clubfoot therapists are appropriately trained:
1. The development of a training course for clubfoot treatment in Africa: learning points for course development
https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-018-1269-0
 
2. The feasibility of a training course for clubfoot treatment in Africa: A mixed methods study
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0203564
 
We found an unmet need for how to measure success of long-term treatment, and clubfoot clinic functionality. What is 'good clubfoot correction'? How do we measure the functionality of a clubfoot clinic? We therefore developed two tools to assist clubfoot therapists monitor their resultsand to enable programme managers to monitor the national clubfoot service provision.
 
1. Assessing Clubfoot Treatment score: https://jfootankleres.biomedcentral.com/articles/10.1186/s13047-019-0323-4
2. Functionality Assessment Clubfoot clinic Tool: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6104708/.
 
We also looked at:
 
1. Incidence of clubfoot:https://onlinelibrary.wiley.com/doi/full/10.1111/tmi.12833
 
2. Assessment of how success is measured:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5688674/
 
3. What a good outcome of clubfoot treatment is:
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0190056
 
Studies to refine and test the ACT and FACT scores in other settings in Africa are now needed, and strengthening multiple pathways of the health system will ensure that all children born with clubfoot can ‘Run Free’.
 
Authors: Tracey Smythe, Allen Foster and Chris Lavy
With acknowledgement to the Africa Clubfoot Training team, The Zimbabwe Ministry of Health and Child Care, The Parirenyatwa Clubfoot Clinic and Orthopaedic Department and Zimbabwe Sustainable Clubfoot Programme.

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