Meet Mr. Clubfoot, a Pioneer of Ponseti in Africa
Meet Diriisa Kitemagwa, orthopedic officer at the Mulago Clubfoot Clinic in Kampala, Uganda. But the title he’s better known by: Mr. Clubfoot. Diriisa and a small team of pioneering health workers started treating the condition, which affects 1 in 800, over two decades ago in Uganda. Their advocacy and training efforts are the foundation of our global work today.
Diriisa has trained and mentored a network of hundreds of health workers to identify and treat this leading birth defect. Thanks to his work, thousands of children today can walk and run for life.
A global movement, born in Iowa and Uganda
Until the past decade, most children born with clubfoot in low- and middle-income countries (LMICs) were not treated due to the complexity of surgery and limited access to safe services. Surgery, the popular option until the 2000s, was costly and also caused issues later in life: the feet tend to become stiff and weak, causing pain and requiring additional operations.
Diriisa was part of a small orthopedic team that helped revolutionize clubfoot care in LMICs by using the Ponseti Method. Overwhelmed by cases of untreated clubfoot—and with only a handful of surgeons, some from abroad on medical missions to treat other pediatric disabilities, like Polio—they knew an alternative to surgery was the only way to reach more children.
But even in the United States, until the early 2000’s, surgery was widely accepted as the standard of care. Most of the 500,000+ Americans today who were born with this condition were treated surgically, and the same was true in Europe and other countries with advanced health systems.
An alternative had long existed—a series of casts and gentle manipulation, followed by a brace worn at night—called the Ponseti Method for the orthopedic surgeon who developed it at the University of Iowa in the 1950s. But few parents knew about it since most physicians were only trained to address clubfoot surgically.
With the advent of the internet, the Ponseti Method gained visibility and traction. Physicians like Shafique Pirani and Norgrove Penny, part of the team working to treat clubfoot and polio disability in Uganda, realized the potential it offered in low-resource settings. After training with Dr. Ponseti in Iowa, Dr. Pirani returned and began training the local team in the new approach.
Uganda eventually became the first country in the world to address clubfoot using a public health approach and to introduce care into national health strategies starting in the early 2000s.
In a few years, the team, which also included MiracleFeet East Africa Program Manager Marieke Dreise and medical advisory board member Dr. Norgrove Penny, went from performing 150 operations per year on older children with neglected cases, to reaching more than 500 annually with casting at public health centers and hospitals. By 2002, in less than three years, they had trained 180 orthopedic officers throughout Uganda in the method.
Their work to advocate for clubfoot treatment nationally—and to eventually train hundreds of physiotherapists and orthopedic specialists throughout east and southern Africa in the Ponseti Method—provided the foundation for MiracleFeet and partners’ work today.
MiracleFeet works in partnership with Comprehensive Rehabilitation Services Uganda (CoRSU) Hospital in 24 clinics to increase access to clubfoot treatment for children across the country.
A radical difference
Reflections from the first physician to use Ponseti in Africa
For decades, clubfoot was only treated surgically. “These were among the most complicated procedures we learned,” said Dr. Norgrove Penny, a member of MiracleFeet’s medical advisory board, who helped revolutionize clubfoot care in LMICs when he and a small orthopedic team began using the Ponseti Method in Uganda.
“Here was a technique I could implement there and make a radical difference in treating a big problem. I think all pediatric orthopedic surgeons will tell you that the Ponseti Method was nothing short of revolutionary. Had I been in North America, I would have been a slower adopter, but I had no choice in Uganda.”
The team went from performing 150 operations per year on older children with neglected cases, to reaching more than 500 annually with casting at public health centers and hospitals. By 2002, in less than three years, they had trained 180 orthopedic officers throughout Uganda in the method.