June 3 marks World Clubfoot Day that raises awareness on clubfoot disability and its prevention.

Clubfoot is a birth defect where one or both feet are rotated inward and downward. The affected foot and leg may be smaller than the other. In about half of those affected, both feet are involved. Most cases are not associated with other problems. Without treatment, people walk on the sides of their feet, which causes problems with walking.

Initial treatment is most often with the ‘Ponseti method’, a non-surgical treatment that includes gentle manipulation of the feet followed by the application of plaster casts and temporary bracing, which ensures full treatment of the foot/feet.

In Rwanda, the day will be celebrated on June 6 at Muhima and Ruhengeri hospitals.

Organised by Cure International/Rwanda Clubfoot Program in partnership with the Ministry of Health and a number of hospitals, the activities will include treating children with clubfoot and creating awareness of the condition, especially on early diagnosis and treatment. Cure International is in its final stages of changing its name to ‘Hope Walks’—this will be effective July 2019.

Jean Claude Habyarimana, the programme manager, says the platform started its operations in Rwanda in 2009, and it has been spearheading prevention of the disability and working with various hospitals in the country to treat the deformity.

Today, there are 23 hospitals across the country working with the programme to treat clubfoot.

Inkuru Nziza Orthopaedic Paediatric Hospital in Gikondo, Muhima, Kibagabaga, Gikondo and Masaka Hospital are just some of the infirmaries in Kigali that provide the treatment on clubfoot.

Habyarimana says they all use Ponseti method which includes manipulation, casting (to apply the plaster on the deformed foot), tenotomy (cutting Achilles’ tendon) as well as wearing foot abduction braces.

The programme focuses on children in the infancy stage (birth to two years old). After the age of two, clubfoot can be treated but the Ponseti method cannot be successful alone, making the defect difficult to correct completely.

He says the reason is that after two years, this method of treatment cannot guarantee 100 per cent successful treatment.

Although it can be treated, he says, it’s expensive compared to the Ponseti method. It requires other methods, including surgery, and there could be side effects as well.

UNDERSTANDING CLUBFOOT

According to Emmanuel Nsengiyumva, a specialist in paediatric orthopaedic surgery working with Rwanda Clubfoot Program, says clubfoot is a congenital deformity and children are born with it, if not treated, it develops into permanent disability that prevents people from walking freely.

He notes that this is a congenital birth defect where a baby is born with one or both feet twisted downwards and inwards in a rigid position.

Every year, around 11,000 babies are born in sub-Saharan Africa with clubfoot. If left untreated, the child will be unable to walk properly, leading to a life of disability.

Early and effective treatment with the Ponseti Method allows the child to live a life without disability so that they can walk, run and play like any other child.

Recent statistics from Cure International/Rwanda Clubfoot Program in partnership with the Ministry of Health show that 5,775 children have been treated in 23 hospitals under the programme’s support.

Nsengiyumva says the deformity starts at around 15th week of pregnancy and the cause is still unknown.

However, he says if a relative had the condition, the possibility of one giving birth to a child with the deformity is high.

He says that going with the Rwandan population, at least one out of two births per 1,000 children are born with clubfoot deformity.

"With sonography, a gynaecologist or obstetrician can be able to identify the problem, therefore making it easy to follow up on the child after they are born, thus proper treatment can be availed as soon as possible,” Nsengiyumva says.

COMPLICATIONS

If the child doesn’t get the required assistance while still young, Nsengiyumva says as they grow, there face difficulties in general, including walking, as well as stigma from society.

"The deformity is treatable when the child is still young but becomes complicated when they are three years and above,” he says.

Nsengiyumva notes that for such children, or an adult with untreated clubfoot, it’s difficult to wear normal shoes like others.

He explains that sometimes children with clubfoot tend to walk using all sides of their feet, and such regions of the foot are not meant to be used to walk. Due to this, there could be chronic arthritis in such areas, making it hard for them to walk.

Depending on the severity of the deformity, Nsengiyumva says as children grow, it gets even more complicated.

TREATMENT

Medics say clubfoot will not improve without treatment. Leaving the foot untreated increases the risk of complications later in life.

Treatment occurs during the weeks after birth. The aim is to render the feet functional and free of pain.

Pascasie Uwamahoro, a physiotherapist at HVP Gatagara Gikondo, School for children with disabilities, says clubfoot may be diagnosed after the baby is born.

She says when a baby is born, the doctor is supposed to examine the feet, arms, hands, hips, and legs to make sure they have no deformities. In case of any, the physician may refer them to a clubfoot clinic for treatment.

She notes that treatment can be by traction, manipulation of the affected foot while the child is still young.

She explains that this is because their bones are soft, especially aged between one week to three years. After the age of three, she says the only treatment is surgery.

"If other methods don’t work, surgery may be used. Surgery aims to adjust the tendons, ligaments, and joints in the foot and ankle, for example, by releasing the Achilles tendon or by moving the tendon that goes from the front of the ankle to the inside of the foot,” she says.

Nsengiyumva says Botox injection may be given to paralyse the Achilles tendons and foot manipulated in a correct position. The child is also given special shoes or braces to support the corrected foot after.

"Everyone should be aware of clubfoot; it can be treated using the Ponseti method by trained health providers,” says Habyarimana.

editor@newtimesrwanda.com