Clubfoot is a congenital condition where one or both feet curve inward — affecting the bones, muscles, tendons, and blood vessels. The feet point down and inward, with the soles of the feet facing sideways. Those affected by clubfoot have difficulty walking and face significant stigmatization that can prevent access to education and later employment. In later childhood, they can develop skin breakdown, pain, and eventual arthritis.
The majority of children with clubfoot have no underlying genetic condition. It is the most common condition treated at CURE hospitals. The medical team in Ethiopia is leading the way in developing best-practice techniques for managing untreated clubfoot. CURE has completed 75,000+ surgeries for clubfoot since our inception in 1996, with an average of 3,000 per year.
If Not Treated
If Not Treated
Without medical intervention, the condition can develop into a serious impairment, making walking painful. For a child growing up with untreated clubfoot, life opportunities are limited with a severe impact on their educational, social, and financial future.
Children with disabilities often experience stigma and discrimination, leading to poor self-confidence and isolation.
Ideally, a child would receive clubfoot treatment early in life when it is less invasive, and their joints are more malleable. However, in low-and middle-income countries, access to adequate medical care is often limited, and many children go years without treatment. This requires different modes of treatment for each age group.
The most common and effective clubfoot treatment for children before age 2, like Prince, is the Ponseti technique. This involves careful stretching of the baby’s foot and holding the position in a specially molded cast that is changed every week. The clubfoot is gradually rotated to a normal position over four to six weeks, at which time a doctor performs a minor procedure where the Achilles tendon is divided under local anesthetic. After a final cast, the baby wears a special brace at nighttime and nap times until four years of age. This brace needs to be changed as the child grows.
Children ages three to ten, like John, still have flexibility in their feet, and they can respond well to casting. After a series of plaster casts, they undergo several surgeries to complete the repositioning of their feet, often including an operation where a tendon is moved from the inside to the outside of the foot. This minimizes the risk of the foot turning inwards again.
Children ages 10-18, like Evance, require a more invasive approach because their joints are no longer flexible. There are different techniques to straighten the foot in an older child. Often surgeons will remove some bone to correct the foot (known as a midfoot osteotomy or triple arthrodesis). Alternatively, an external fixator frame can be used. Here, the surgeons carefully place pins into the bones and connect these to a circular frame. The frame is adjusted daily, allowing the foot to straighten gradually. This approach takes patience and careful attention from the child, parent, and hospital team.