Milestones in clubfoot treatment
Japheth Masawe, his wife Diana Musabi and their two- month old son, Baby Sanuel, who has clubfoot deformation, at the Association for the Physically Disabled of Kenya therapy department in Nairobi on June 3, 2022.
What you need to know:
- Clubfoot is an inborn deformity of the foot, where either or both feet are twisted inward, causing the child to walk on their ankles.
- The condition causes severe lifelong disability if left untreated.
Clubfoot is an inborn deformity of the foot, where either or both feet are twisted inward, causing the child to walk on their ankles. The condition causes severe lifelong disability if left untreated.
Caroline, 30, was devastated. No one in either side of her family had ever had this condition. “I felt as if I was cursed. It was a trying moment of my life,’’ she narrates to Healthy Nation.
At Gatundu Hospital, the baby was immediately placed under correction and a cast applied for two months. He also needed to be placed under maintenance (braces). The mother says she was unable to pay the requisite fee of Sh3500 for the braces.
“I have other children that I take care of, which made it difficult to raise the money. I had to take my son back home with me without the braces.’’ When she raised the money four months later, doctors referred her to Thika and Kikuyu hospitals for treatment.
For Vincent Odhiambo*, the experience was terrifying, exhausting and demoralising when his wife gave birth to their first-born daughter. Afraid of the outcome of the treatment, Vincent never honoured doctor appointments, spending time instead on the internet searching for help. He even considered taking the baby to India for the procedure that would set him back about Sh300000.
‘‘One day during my online searches, I bumped into Hopewalks, a Christian-based organisation in the United States, which provides support for clubfoot treatment. They referred me to their offices in Nairobi,” he recounts.
The baby was put on treatment at AIC Cure Hospital, and the foot began to straighten.
Healthy Nation recently caught up with the family during their third visit to the facility in Nairobi. Odhiambo’s initial despair had been replaced with radiance and hope. “My daughter is one month old now. Her mother and I are certain that everything will be alright.’’
For Ms Mary Mburu, she thought of abandoning her child, who was born with clubfoot deformity, at Mbagathi Hospital after delivery. She could not imagine nursing a child with such a deformity.
“The thought of my child being disabled made me cry all the time. I was later consoled by a doctor, who told me that her child, who was born with clubfoot, was now walking. I immediately enrolled my child at Mbagathi for correction and through consistency, he is now walking just like any other children,” says Mary.
To treat clubfoot, a procedure called tenotomy is performed. This involves releasing the tendon above the heel that tightens the leg. Thereafter, the patient is put under braces.
Vincent says that while doctors are aware of the condition, getting the right treatment in the country is difficult. Having gone through the agony of finding treatment for his child, the father notes that there is need for sensitisation on the condition, saying this would help to address stigma.
One victim of clubfoot stigma is Mary Asingira, a mother of three, who was disowned by her husband’s family after learning her child had the condition.
“It has been difficult for me to take care of my son as a single parent,’’ says Asingira, 40. Even after paying Sh132,000 for an operation at Kijabe Hospital, the son is still unable to walk. But Mary remains optimistic. Her son is currently undergoing treatment at AIC Cure Hospital in Nairobi, and she hopes he will walk one day.
According to the Disease Control Priorities 3rd Edition, Essential Surgery, over 50 per cent of disability-adjusted life lost each year due to congenital anomalies (clubfoot) could be avoided with prompt surgery.
According to the World Health Organization (WHO), approximately 150,000 – 200,000 babies worldwide are born with the condition annually. A WHO report shows that 80 per cent of all untreated clubfoot anomalies are in developing countries.
The global health body recommends the Ponseti treatment method, a non-invasive, low-cost procedure with a 98 per cent success rate. Ponseti consists of manually aligning the child’s foot with the application of a series of casts.
It can take as few as five casts and about three weeks to set the child on the path of a normal life, without surgery.
The Clubfoot Care for Kenya (CCK) says more than 13 600 children have been treated through their partner 28 clinics across the country. Through partnership with local hospitals, CCK, a subsidiary of Hopewalks, supplies materials for clubfoot treatment and maintenance, from plasters to braces and free training to clinicians.
The organisation was formed in 2005 to provide free services to children born with the deformity. It works in partnership with the Ministry of Health and the Association of the Physically Disabled of Kenya (APDK). Other partners include the Kenya Medical Training College and Moi Teaching and Referral hospital.
In a joint survey by WHO and CCK, it has emerged that 90 per cent of clubfoot cases are not inherent. Dr Paul Mang’oli, an orthopedic surgeon, who is also in charge of clubfoot in Kenya, says the condition is manageable, especially when identified earlier.
“In all the clinics in Kenya, we do a non-surgical treatment to the child ranging from casting, tenotomy and finally the child is put in braces for five years,’’ says Dr Mang’oli, noting that treating this condition would help to reduce the level of disability in the country by a significant percentage.
Treatment for clubfoot is available in Nairobi, Kiambu, Mombasa, Homa Bay, Trans Nzoia, Kilifi and Taita Taveta counties. Other counties are Siaya, Nakuru, Murang’a, Kisii, Kakamega, Bungoma and Kisumu. According to Dr Mang’oli, this treatment is also offered in the counties of Kericho, Machakos, Eldoret, Nyeri and Embu.
Treatment procedure
Dr Mang’oli says clubfoot treatment should begin soon after birth. Treatment involves two stages: correction (casting and tenotomy) and maintenance.
Stage 1: correction (casting)
In the correction stage, the clubfoot is gently manipulated by massaging. It is then directed to a certain position by applying a plaster cast from the toes to the top of the leg. This holds the manipulation in place.
In this stage, most children will need six to eight weeks in a cast to fix their feet. Weekly checkup sessions are required and for a new cast to be applied.
Dr Mang’oli advises that the caregiver should ensure the cast is in place, clean and dry and check for slips and swelling. They should also play with the toes of the child to relieve them.
Tetonomy follows. This procedure comes before the last cast. It involves the doctor releasing the tendon above the heel with a simple cut which takes a few minutes. The final cast is then applied. This will stay for three weeks.
Stage 2: Maintenance
After the last cast is removed, the child’s feet should be straight. Treatment, though, has to continue. Doctors argue that if not properly maintained, the condition can be reversed within the first five years of life.
For the first three months, the child is required to wear braces for 23 hours a day. Thereafter, they wear them at night and during naps for a minimum of 12 hours per day until they are five.
