In a brightly-lit doctor’s office in the north of Zimbabwe’s capital, Harare, nine-month-old Innocent plays distractedly with a facemask as a physician removes the plaster casts from his legs. His mother, Rosewitter, stands nearby, watching anxiously. After briefly examining the baby’s feet, the doctor nods approvingly and a relieved smile breaks across Rosewitter’s face.

Nine months earlier, in the maternity ward of a Sally Mugabe Central Hospital, she felt a deep surge of anxiety after laying eyes on her baby’s feet for the first time. Born with clubfoot, one of the world’s most common birth defects, Innocent’s feet were bent sharply inwards at right angles from his legs.

“I didn’t know what it was,” she said, recalling the moment. “I’d never seen anything like it. I was so upset.”

Despite affecting roughly one in every 700 babies, clubfoot is rarely seen in countries with advanced health systems as it is routinely treated soon after birth. But in low- and middle-income countries like Zimbabwe, it frequently goes uncorrected which leads to long-term disability. Of the 200,000 new cases each year, an estimated 144,000 do not receive any treatment.

“I imagined how other children would laugh at him and how people would discriminate against him.”

Innocent’s mom, Rosewitter

Soon after Innocent’s birth, a doctor told Rosewitter that her son had clubfoot, but this meant little to her at the time. The long-term consequences of the condition were not yet apparent to her, plus no one told her it was treatable let alone that the treatment was simple, non-invasive, and entirely free at a nearby MiracleFeet-supported clinic.

“I imagined how other children would laugh at him and how people would discriminate against him,” said Rosewitter aware of the severe and pervasive stigma people with disabilities often face in Zimbabwe. “It’s not easy having a disability here.”

In the underprivileged suburb of Hopley where Rosewitter lives in a one-room cinder-block home with her husband and Innocent, life is hard enough for the able-bodied. Growing up there with a disability could entail untold hardships. What made her anxiety worse was that, like many mothers of babies with clubfoot in the region, Rosewitter blamed herself. And so did many of those around her.

“People were saying it was because I didn’t drink enough fluids during pregnancy, or because I was too stressed, or I was wearing clothes that were too tight,” she recalls. The stigma and gossip caused Rosewitter to wonder if her child was in fact cursed. 

Her stepmother suggested a traditional therapy involving wrapping a towel soaked in hot water around the foot and trying to manually force it straight, but the procedure simply caused Innocent to howl with pain. After an agonizing week of uncertainty, Rosewitter returned to the hospital looking for answers. Fortunately, a nurse explained that treatment for Innocent’s feet was not only possible, but highly effective and available for free at a nearby clinic.

Ten years ago, Zimbabwe, like much of the Global South, had few systems in place to treat effectively clubfoot. As a result, a person in Innocent’s position would have had little option but to learn to live with his disability as best he could. But over the last decade, something of a transformation has taken place in this southern African nation.

Today, more than 50% of children born with clubfoot in Zimbabwe are successfully treated.

This dramatic shift is in large part the result of the tireless work of the Zimbabwe Sustainable Clubfoot Program (ZSCP), MiracleFeet’s local partner organization, which has been striving to increase access to treatment throughout the country since 2010. Working in collaboration with the Ministry of Health and Child Care, the team supports 14 clinics across Zimbabwe where clubfoot patients can receive Ponseti treatment, a non-surgical, low-cost and effective method that is successful in 95% of cases.

Now recognized as the global standard, the method involves using a series of plaster casts to correct the position of the feet, followed by a five-minute procedure to snip the Achilles tendon. A foot abduction brace is then worn at night for the next few years to prevent relapse. Previously, clubfoot treatment had involved undergoing surgery, a near impossibility for most in a country like Zimbabwe with a chronic shortage of trained surgeons, not to mention the significant cost.

“So much has changed,” says Dr. Tracern Mugodo, the ZSCP’s clinical manager. “In the past, when other methods were used, they were often actually making the condition worse. But most people couldn’t access treatment anyway, so those are the people we’re seeing now, the teenagers and adults who are coming to us with cases of untreated clubfoot.”

As for the remaining cases each year still going untreated, these are mostly in remote, rural areas, explains Dr. Tracern, the country’s first and only female orthopedic surgeon.

“In rural areas, people think it’s because the child has been bewitched or cursed, or that it’s a punishment from ancestors because the mother has been promiscuous,” she said. “And even if they know where to go for treatment, many of them don’t have the money to get there.”

The Zimbabwe Sustainable Clubfoot Program subsidizes travel costs for many patients, but it’s not always enough to cover the full journey, which sometimes involves multiple days of travel each way and must be undertaken every week for six to eight weeks during the casting phase of treatment when new casts are applied to gently manipulate the feet.

When Rosewitter first brought Innocent to the ZSCP clubfoot clinic at Harare Hospital, for fear of disappointment, she couldn’t allow herself to believe that one day her son would be able to walk. After being referred to Ryan Bathurst, Physiotherapist and Director of the ZSCP, it emerged that Innocent’s clubfoot had a neurological component that made it harder to treat. Nevertheless, it wasn’t long before his mother began to see dramatic improvements.

“He doesn’t cry anymore and I can really see the change in his feet,” she said. “The right foot is completely fine and the left just needs a little more correcting.” When Innocent’s final casts come off later this month he’ll wear a foot abduction brace to make sure his feet stay in their new position, and by the time he’s two years old he’ll be every bit as mobile as any other toddler.

“He would have had such a hard life without this treatment,” said Rosewitter as she took down the laundry from the clothesline outside her house, her son strapped tightly to her back, the tips of his casts poking out from beneath her wrap. “But now I feel so optimistic. His future is bright.”

^{Special thanks to Oak Foundation for their generous support of the Zimbabwe clubfoot program.}