Clubfoot: The neglected deformity in babies

When Vestine Nirere, 26, a resident of Nyakinama village in Musanze District, had her first birth, she was shocked to learn that the child was not as normal as other children. The child was born with a condition called clubfoot. “I gave birth at home but when my husband came to learn that the child had some abnormalities, he rejected me and sent us away. I went back to my family from where I discovered through a radio advert that Ruhengeri clinic could treat the condition. “I later visited the clinic for the treatment. With the help of a counsellor, we were able to convince my husband and he finally accepted me back,” narrates Nirere. After undergoing various therapies, the child has since recovered and is living normally like other children. What is clubfoot? Clubfoot is a congenital deformity that severely twists the foot downward and inward, making walking difficult or impossible. It can affect one foot (unilateral) or both feet (bilateral). According to the World Health Organization (WHO), clubfoot is one of the most common congenital physical disabilities worldwide, known to occur in 1-3 of every 1,000 births with evidence of higher rates in developing nations. According to Esperance Uwizeye, a programme manager at Cure International, Rwanda experiences about 150-700 new cases of clubfoot every year, with the biggest number being boys. Cure International is an NGO working in Rwanda to create awareness about clubfoot. It also provides training health personnel to put casts and correct clubfoot without invasive surgery. Asked what causes clubfoot, Uwizeye says: “For the vast majority of cases, there is no known cause although genetic and environmental causes appear to be linked.” He adds that many patients have been permanently disabled with clubfoot because they didn’t seek early quality treatment. Symptoms and signs of clubfoot Charles Gatsinzi, a physiotherapist at Orkide Medical Centre in Kigali, says the alarming signs and symptoms are summarized in one word: ‘CAVE’ to stand for cavus foot, adductus foot, varus foot and equinus foot. According to medics, Cavus foot means the foot has a very high arch, while Adductus foot refers to a situation when the bones in the front half of the foot bend or turn in toward the body. Furthermore, Varus foot refers to the inversion of the calcaneus relative to the tibia, while Equinus foot is a condition in which the upward bending motion of the ankle joint is limited. “Those are the clear signs and symptoms that your child is having clubfoot and should be rushed to clinics that offer physiotherapy care and treatment. It should commence as early as one week after the child’s birth,” says Gatsinzi. How it is diagnosed, treated Gatsinzi says clubfoot may be diagnosed after the baby is born. “When a baby is born, the doctor examines their feet, arms, hands, hips and legs to make sure they have no deformities. In case of any, the doctor may refer them to Clubfoot Clinic for treatment. According to Dr Rachna Pande, a specialist in internal medicine at Ruhengeri Hospital, there are different ways of treating clubfoot. “Treatment is by traction, manipulation of the affected foot while the child is still young and the bones are soft at the age of between one week to 3 years. After the age of 3, the only way of treatment is by surgery,”“Botox injection may be given to paralyze 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. In case of severe cases, surgery is recommended to correct the abnormalities,” says Pandey Some of the clinics that offer clubfoot treatment in Rwanda include; Gikondo, Ruhengeri, Gisenyi, CHUB, CHUK, Nyamata, Kibagabaga and Nyagatare among others. editorial@newtimes.co.rw