Every newborn with clubfoot has a right to treatment.
Clubfoot is one of the most common birth defects and a major cause of physical disability globally. The vast majority of cases are diagnosed at birth and occur in otherwise healthy babies. Clubfoot is easily identifiable by the way the feet face inward and upward. Left untreated, this disability makes walking extremely difficult and painful. However, the position of their feet is the only medical obstacle preventing most children with clubfoot from living fully functional, productive lives.
There are 9.8 million people alive today who were born with clubfoot, of those 7.8 million live with disability due to lack of access to proper treatment. An estimated 200,000 children are born with clubfoot globally, or 1 in 700, but this rate is likely underestimated.* With proper treatment, more than 95% can achieve full correction and mobility. Without treatment, children live with a severe impairment and endure a lifetime of negative health, social, and economic consequences.
Clubfoot is correctable with the Ponseti method–a highly effective, low-cost, innovative medical intervention that results in complete correction of clubfoot and full functionality in nearly all cases. Treatment involves a series of weekly casts to gently reposition the feet and a simple outpatient procedure to release the Achilles tendon, followed by use of a foot abduction brace, worn for 4-5 years while sleeping to maintain the correction and reduce the chance of relapse. When initiated during infancy, the position of the foot is usually corrected within six to eight weeks.
Children treated with the Ponseti method experience fewer long-term complications than those treated surgically. Between 2005- 2010, evidence of the long-term complications associated with surgery mounted and countries around the world embraced the Ponseti method as the standard of care. Since then, researchers have continued to document the method’s excellent short- and long-term outcomes in low- and high-income countries alike.
A variety of healthcare professionals, such as physical therapists and casting technicians, can be easily trained to provide the treatment. The method does not require general anesthesia or surgical capacity, involves only basic medical materials, costs about $500 USD per child, and achieves superior long- term results compared to surgery.
*Birth prevalence of clubfoot ranges from 1.11/ 1000 live births in Africa to 2.03/1000 live births in Europe (Smythe et al, 2017). Given that there is a recognized overall data gap in estimation of birth defects, we expect the global clubfoot birth prevalence to be about 1.42 per 1000 births. Hence every year, approximately 200,000 babies or 1 in 700 births are affected by clubfoot, worldwide.
- Birth defects surveillance: A manual for programme managers, 2nd Edition: World Health Organization; 2020.
- Foster HE, Scott C, Tiderius CJ, Dobbs MB, Members of the Paediatric Global Musculoskeletal Task F. Improving musculoskeletal health for children and young people – A ‘call to action’. Best Pract Res Clin Rheumatol. 2020;34(5):101566.
- Cady R, Hennessey TA, Schwend RM. Diagnosis and Treatment of Idiopathic Congenital Clubfoot. Pediatrics. 2022;149(2).
- Smythe T, Kuper H, Macleod D, Foster A, Lavy C. Birth prevalence of congenital talipes equinovarus in low- and middle-income countries: a systematic review and meta-analysis. Trop Med Int Health. 2017;22(3):269-85.
- Owen RM, Capper B, Lavy C. Clubfoot treatment in 2015: a global perspective. BMJ Glob Health. 2018;3(4):e000852.
- Laaveg SJ, Ponseti IV. Long-term results of treatment of congenital club foot. J Bone Joint Surg Am. 1980;62(1):23-31.
- Grimes CE, Holmer H, Maraka J, Ayana B, Hansen L, Lavy CBD. Cost-effectiveness of club-foot treatment in low-income and middle-income countries by the Ponseti method. BMJ Glob Health. 2016;1(1):e000023.
- Clubfoot: American Academy of Orthopaedic Surgeons; [Available from: https://orthoinfo.aaos.org/ en/diseases–conditions/clubfoot/.
- Balasankar G, Luximon A, Al-Jumaily A. Current conservative management and classification of club foot: A review. J Pediatr Rehabil Med. 2016;9(4):257-64.
- Halanski MA, Davison JE, Huang JC, Walker CG, Walsh SJ, Crawford HA. Ponseti method compared with surgical treatment of clubfoot: a prospective comparison. J Bone Joint Surg Am. 2010;92(2):270- 8.
- Svehlik M, Floh U, Steinwender G, Sperl M, Novak M, Kraus T. Ponseti method is superior to surgical treatment in clubfoot – Long-term, randomized, prospective trial. Gait Posture. 2017;58:346-51.
- Zionts LE, Sangiorgio SN, Ebramzadeh E, Morcuende JA. The current management of idiopathic clubfoot revisited: results of a survey of the POSNA membership. J Pediatr Orthop. 2012;32(5):515-20.
- Shabtai L, Specht SC, Herzenberg JE. Worldwide spread of the Ponseti method for clubfoot. World J Orthop. 2014;5(5):585-90.
- Kuper, H., & Heydt, P. (2019). The Missing Billion: Acces to Health Services for 1 Billion People with Disabilities. Missing Billion Initiative. Retrieved from https://www.themissingbillion.org/the-report-2
- *Smythe T, Kuper H, Macleod D, Foster A, Lavy C. Birth prevalence of congenital talipes equinovarus in low- and middle-income countries: a systematic review and meta-analysis. Trop Med Int Health. 2017 Mar;22(3):269-285. doi: 10.1111/tmi.12833.
- United Nations Children’s Fund, A Statistical Profile of Birth Registration in Africa, UNICEF, New York, 2020.
- Based on an estimate of 158000 cases in LMICs and 24,436 reported as enrolled for treatment in 2015.
- The Global Clubfoot Initiative says this is a conservative estimate, that 18 years ago nearly zero children in LMIcs were receiving the Ponseti method, according to biannual country surveys beginning in 2005.
- Morcuende, J. A., Dolan, L. A., Dietz, F. R., & Ponseti, I. V. (2004). Radical Reduction in the Rate of Extensive Corrective Surgery for Clubfoot Using the Ponseti Method. Pediatrics, 113(2), 376-380. doi:https://doi.org/10.1542/peds.113.2.376
- Ventura, S. J., Martin, J. A., Curtin, S. C., & Mathews, T. J. (1998). Report of Final Natality Statistics, 1996. Monthly Vital Statistics Report, 46(11). Retrieved from https://data.nber.org/natality/1996/docs/mv46_11s.pdf
- Mai, C. T., Isenburg, J. L., Canfield, M. A., Meyer, R. E., Correa, A., Alverson, C. J., . . . Kirby, R. S. (2019). National population-based estimates for major birth defects, 2010-2014. Birth Defects Research, 111(18). doi:doi.org/10.1002/bdr2.1589
- Centers for Disease Control and Prevention. (2020). Data & Statistics on Birth Defects. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/ncbddd/birthdefects/data.html
- Limitations include the availability and reliability of data from LMICs, reliance on clinic data, exclusion of studies not published in English.
- Ansar, A., Rahman, A. E., Romero, L., Haider, M. R., Rahman, M. M., Moinuddin, M., . . . Hoque, D. M. (2018). Systematic review and meta-analysis of global birth prevalence of clubfoot: a study protocol. BMJ Open, 8(3), e019246. doi:doi.org/10.1136/bmjopen-2017-019246