Treating clubfoot, transforming lives

Every year 200,000 babies are born with clubfoot and, of the nearly 10 million people alive today who were born with it, as many as eight million have never received treatment. In late 2022, BBC reporters visited Senegal to hear directly from patients and families searching for clubfoot care. This article details the emotional stories they encountered as well as the passion they witnessed from MiracleFeet partners, providers, and ambassadors.

The Pan American Health Organization (PAHO), WHO’s regional office of the Americas, and MiracleFeet just launched an open access virtual course on clubfoot highlighting the importance of early identification, the surprisingly high prevalence, and impact of untreated clubfoot – a major cause of disability worldwide. This course, available in English and Spanish, is aimed primary at frontline health workers and includes a close look at clubfoot—the most common congenital cause of physical disability worldwide affecting an estimated 200,000 babies every year. The course presents essential information on the non-surgical, low cost, and extremely effective Ponseti method, the orthopedic treatment standard. “This course is a tremendous opportunity to raise awareness and promote the integration of early detection and referral into healthcare systems,” says Daphne Sorensen, CEO of MiracleFeet, “so that every baby born with clubfoot starts treatment early, ideally within in the first few weeks of life.” Dr. Betzabé Butrón Riveros, Regional Advisor on Child Health at PAHO adds, “when we recognize and address clubfoot we can change an entire life in a matter of weeks. We cannot leave these children behind.” The self-directed and self-paced virtual course includes four modules and four key learning outcomes. Modules and learning outcomes Modules What is clubfoot? The case for treating clubfoot Clubfoot treatment The role of the health worker Learning outcomes Familiarity with the characteristics of clubfoot and other common birth impairments Knowledge of the Ponseti method—a simple, low-cost technique—and how it can be used to effectively treat clubfoot Understanding of the importance of early detection and referral and the role healthcare workers play in examining children for birth impairments Reflect on community perceptions of birth impairments and learn through examples how to communicate with families in a supportive and encouraging way, avoiding stigma and misinformation. Through this course, MiracleFeet and PAHO are working together to support regional and country level actions to prevent the life-long disability caused by untreated clubfoot. This partnership signals deserved recognition in awareness raising for clubfoot and the need for expanded access to its low-cost treatment. “Early detection and referral of children with conditions like clubfoot is crucial to help them access the rehabilitation they need when it can help the most,” says Antony Duttine, Regional Advisor, Disability and Rehabilitation at PAHO. “Early childhood development is critically linked to lifetime outcomes. Access to services improves a child’s ability to learn and play from infancy, and generates greater gains throughout their lives, compared to deferred intervention.” Increasing early access to clubfoot treatment will transform many young futures, especially in low- and middle-income countries where four out of five children do not have access to care. The course also aligns to the Sustainable Development Goal #3 and with PAHO’s commitment to improve children’s health and quality of life. Training healthcare workers to identify and refer clubfoot cases means more children will have access to not only mobility, but also independence, education, and employment opportunities. “When we recognize and address clubfoot we can change an entire life in a matter of weeks. We cannot leave these children behind.”Dr. Betzabé Butrón Riveros The course is free and available at the Virtual Campus for Public Health of the Pan American Health Organization (PAHO), a network of people, institutions and organizations who have been sharing public health courses, resources, and information since 2008.  With 1.7 million users, participants who review the educational material, pass the evaluations, and answer the Virtual Campus quality survey can download the certificate of participation and approval issued by PAHO. “Building awareness of clubfoot and other birth impairments within the Americas will lead to more babies being referred for treatment, and more children accessing the rehabilitative care which is their right,” says Anna Cuthel, MiracleFeet’s Technical Director.   More from MiracleFeet Honoring Zimbabwe’s First Female Orthopedic Surgeon on International Women’s Day MiracleFeet Featured in BBC News A legacy of empathy brings clubfoot care to children in Nepal External Evaluations Showcase MiracleFeet’s Remarkable Impact

Driven by a desire to understand the long-term effects of our programs on the children and families we serve, MiracleFeet contracted impact measurement firm 60_decibels to evaluate outcomes and experiences of caregivers whose children have received gold-standard treatment for clubfoot through MiracleFeet programs in nine countries over the past four years (2019 – 2022). The mixed-method evaluation analyzed responses from phone interviews with 2,051 caregivers of patients who were treated by MiracleFeet’s partner hospitals and clinics in India, Nicaragua, Paraguay, the Philippines, Uganda, Tanzania, Madagascar, Sri Lanka, and a ninth country kept confidential by agreement with the partner and Ministry of Health. “My child can now walk properly, play with other children, and run without feeling any pain.” Caregiver in Uganda The results were extremely positive. Overall, caregivers reported a strong positive impact on their child’s life after undergoing clubfoot treatment. 97% report that their child’s quality of life has improved 93% say their child can walk with little or no difficulty 88% report no challenges with treatment from MiracleFeet’s partners The findings also revealed challenges families face in finding and completing treatment. The most frequently reported include long wait times at clinics, long travel times and distances to find care, and issues with the foot abduction brace used to maintain the foot correction and prevent relapse. Drawing from these findings, we now anticipate these issues and work closely with partners to address them within the specific context and circumstances. In many areas we are providing travel subsidies, transportation assistance or mobile services, and have made the MiracleFeet brace available to all partners.     “I’ve watched MiracleFeet transform lives…and it’s thrilling." Nicholas Kristof, The New York Times Less than $500 changes a life. Caregivers report strong satisfaction with treatment outcomes across all nine countries over the four years of conducting these surveys suggesting that MiracleFeet’s model and the Ponseti method are both highly effective and inherently scalable. MiracleFeet consistently strives to achieve the highest impact possible in alignment with our mission to end the disability caused by untreated clubfoot. This external review validates the impact providing high-quality clubfoot treatment has on children’s lives. We plan to expand our external impact evaluation efforts and gather more detailed and specific data in future studies, especially in countries where we have worked for many years and have a broad set of patient experiences to pull from. More from MiracleFeet Nothing stands in the way of Leon’s dreams, thanks to his mom From Casts to Choreography: There’s no looking back for this young dancer Sulekha and Sushavam: Surmounting stigma and racing into a new life  Catching up on childhood with two straight feet