Relief for babies with twisted feet

Ms Beth Wangari with her son Ian Ngatia who has been wearing a club foot brace at night to correct a foot deformity. The foot has been since been corrected with the continuous use of braces. Photo/JENNIFER MUIRURI

When she gave birth last year, things seemed normal, until the nurses noticed that her baby girl’s feet were curved inwards.

Teresia Wanjiru’s daughter, Mary Muthoni, was diagnosed with club foot, and for her this marked the beginning of innumerable medical sojourns.

But today she is glad the club foot was caught early at Naivasha District Hospital.

She was referred to the hospital’s orthopaedic department for a treatment that would correct the positioning of her baby girl’s feet.

Club foot is a condition where a baby’s foot is twisted out of shape or position.

Though it is not a painful condition, if left untreated it can lead to significant discomfort and disability in the teenage years of the child.

The term “club foot” refers to the way the foot is positioned at a sharp angle to the ankle, like the head of a golf club.

Foot upside down

Occupational therapist Mwangi Mahinda says in some cases, the affected foot may be turned so severely that it actually looks as if it’s upside-down.

Little Muthoni’s feet had both curved inwards and required to be put on treatment right away — four weeks of casting done every week to align the feet.

Casting is the use of a stiff dressing or casing, usually made of plaster of Paris, used to immobilise body parts, the feet in this case.

“The casting is placed from the groin to the feet in order to hold it in position as compared to the earlier method where the cast was put at the ankle-level and sometimes it slipped,” Mr Mahinda said.

According to Mr Mahinda the treatment should start immediately the problem is noted, ideally, shortly after birth when it is easiest to reshape the foot.

After the casting the child is expected to wear braces.

“If the child grows with the club foot, it may pose image and confidence problems later on,” Mr Mahinda noted, adding that the severity of club foot can range from mild and flexible to severe and rigid.

“It can also affect either one foot, unilateral, or can affect both feet, referred to as bilateral,” Mr Mahinda told the Nation at Naivasha District Hospital.

The cause of club foot is not known, but the condition may be passed down through families in some cases.

In some cases, club foot can be associated with other congenital abnormalities of the skeleton, such as spina bifida, a serious birth defect that occurs when the tissue surrounding the developing spinal cord of a foetus doesn’t close properly.

Environmental factors have also been found to play a role in causing club foot with studies linking to a family history.

If a woman with a family history of club foot smokes during pregnancy, her baby is at risk of the condition approximately 20 times greater than average.

Club foot is a congenital condition that occurs in about one or two of every 1,000 children born in Kenya, and is common in males, though researchers have not given reasons for this observation.

“The staff at the clinic explained the procedure of treating the club foot and I was confident that by the time she is one year, she would be running around like her age mates born without the condition,” Wanjiru explained.

Once a child has been diagnosed with club foot, a scoring system is used on each affected foot using various indicators to ascertain the severity of the condition.

The scoring system is known as the Pirani scoring system. The least (best) total score for all categories combined is 0, and the maximum (worst) score is 6.

It is also used to monitor the correction and is recorded at every visit to the hospital for recasting, he added.

“The higher the score the more the severity of club foot deformity,” Mr Mahinda pointed out.

Ms Jane Waithera’s four month old son Bernard Kimani is currently in a cast and undergoing treatment for club foot that was noticed at birth.

Ms Waithera travelled to Naivasha from her home in Loitoktok to seek treatment for her son, and is optimistic he will walk normally.

“The treatment started early enough so Bernard may never know he was born with club foot unless he sees the photos taken earlier,” Ms Waithera told the Nation from Naivasha where she is staying with relatives for the next two months when her son is expected to complete treatment.

One and a half year-old Ian Muya is also undergoing ongoing treatment of club foot and wears the braces only at night.

According to his mother Beth Wangari, he is expected to wear the braces every day when going to bed until he is two years old.

The a treatment method that involves stretching and casting — known as Ponseti method — has a 98 per cent success rate, according to Mr Mahinda.

The method was developed by the late Dr Ignacio Ponseti of the University of Iowa.

Dr Ponseti’s extensive examination of the anatomy and biology of infant feet in the 1950s, led him to believe that physical manipulation and casting might be a more successful approach in treating club foot

“We cast the child’s foot or feet every week for several weeks, always stretching the foot toward the correct position. The heel cord is then released followed by one more cast for three weeks,” Mr Mahinda said.

Toes exposed

The toes are left exposed and are used to monitor the blood circulation in the casted foot in case it is too tight.

While the child still has the cast, parents are advised to report to hospital immediately they notice swollen toes, or any change of colour under the cast.

If the cast appears to be causing significant pain or the toes disappear into the cast these should be reported immediately.

After the shape of the foot is realigned, it’s maintained through stretching exercises, special shoes with braces worn at night for up to two years.

“The child has to wear the shoes day and night for three months and later only at night for one year to prevent the condition from recurring,” Mr Mahinda pointed out.

However, in some cases, severe club foot does not respond to non surgical treatment thus the child may require surgery, a process known as tenotomy.

Tenotomy is the cutting of a tendon and is performed in order to lengthen a muscle that has developed improperly.

The tendons are lengthened to help ease the foot into a more appropriate position.

After surgery, the child needs to wear a brace for a year or so to prevent recurrence of the deformities.

It is performed under local anaesthesia and the child can go home on the same day.

The government and Club Foot Care Kenya are in a partnership to treat all children for free at selected health facilities countrywide.

Referral hospitals — Kenyatta and Moi Teaching treat the condition alongside others spread across the country.

Hospitals where the treatment using the Ponseti method is available include, Nakuru, Kakamega, Embu, Nyeri and Coast Provincial general hospitals.

District hospitals in Molo, Kiambu, Kitale, Kisii, Machakos, Kangundo, Chuka and Kilifi also offer the treatment.

On the day of the interview at their Naivasha home, Muthoni skipped and jumped around the compound bare feet, with no worries.

And she will probably never know she had developed club feet in her childhood.

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