Training at MiracleFeet
Training Tools & Approaches
Qualified health workers are at the heart of MiracleFeet’s mission to eliminate clubfoot disability worldwide. Increasing the number and availability of trained providers is central to our model of expanding sustainable access to treatment.
We do this by training new providers in basic and advanced Ponseti skills, and by developing regional teams of qualified trainers who can grow workforce capacity in their own countries—an approach that reduces costs and increases sustainable access to treatment.
The Ponseti method is well-suited to scaling in low-resource settings because it requires only basic treatment supplies and is relatively straightforward to teach. In addition, it has been well-documented that allied health professionals, such as physical therapists and casting technicians, can be trained in the technique, supporting task-sharing with orthopedic surgeons where appropriate to address the acute shortage of qualified health workers in many regions of the world.
Clinical Curriculum: The ACT Program
Treating clubfoot involves a great deal of tactile training: taking a Pirani score, manipulating the foot, applying casts correctly, and fitting the foot abduction brace. The ACT Program, originally launched as the Africa Clubfoot Training, is a standardized curriculum designed specifically for learning and applying these skills in low-resource settings. The ACT package includes Basic, Advanced, and Train the Trainer clubfoot treatment modules.
MiracleFeet has adopted ACT as our standard global training curriculum. The training program was developed by experts in partnership with the University of Oxford and the Global Clubfoot Initiative, and is accredited by the Royal College of Surgeons in the UK.
The courses have been extensively tested over several years, successfully delivered around the world in English, French, and Spanish, and are widely considered the most comprehensive and practical set of Ponseti training available. (Additional information about the curricula can be obtained from the Global Clubfoot Initiative, a non-profit organization dedicated to supporting clubfoot treatment in low income countries and promoting collaboration among its 30+ member organizations.)
Level 1 | Fundamentals Course
Introduction to clubfoot and the Ponseti Method
- Foot anatomy and definitions
- Pathoanatomy, method of manipulation, applying casts, tenotomy, maintenance using foot abduction braces
- Manipulation and casting using clubfoot models and patient demonstrations.
Level 2 | Advanced Course
Refresher and advanced Ponseti for Idiopathic clubfoot
- Common errors in clubfoot management
- Recognition and treatment of atypical clubfoot, recurrent clubfoot, treating older children, secondary clubfoot
- Parent education and support and clinic quality monitoring and improvement
- Refresher manipulation and casting for idiopathic clubfoot, modified manipulation and casting for atypical clubfoot and treatment demonstrations with patients where possible.
Level 3 | Train the Trainer
Building countries’ capacity to meet their own training needs among expert Ponseti providers
- Effective learning and teaching, leading small group discussions, giving effective feedback, teaching practical skills, giving large group presentations
- How to organize clubfoot courses
- Supervision and mentoring and measuring clubfoot clinic quality.
eLearning with ACT Online
To supplement the hands-on training providers receive using ACT, MiracleFeet is developing a digital version of the ACT curriculum, ACT Online, in partnership with OpenPediatrics at Boston Children’s Hospital. This eLearning platform for providers is designed to enhance training outcomes and serves as a critical reference for new and experienced providers after training is complete, while reducing the cost of training.
3D Clubfoot Model
MiracleFeet has also designed the world’s first 3-D interactive simulation of a clubfoot. Developed by 3DTOZ to supplement mACT, the model enables trainees and Ponseti practitioners to learn key concepts and practice foot manipulation in advance of and following in-person training.
Providers can use the online tool to visualize normal foot and clubfoot anatomy as well as manipulate the clubfoot deformities, correction sequences, and the full Ponseti method. Users can rotate the foot 360 degrees and explore alternate views of the anatomy and manipulations (anterior, posterior, medial, and plantar) and also examine the underlying anatomical layers—bone and tendon structures of the foot.
In addition to training providers in the Ponseti technique, MiracleFeet trains other health workers to build awareness, referral, and treatment networks deep within countries. This includes training:
- Midwives and front-line health workers to identify and refer clubfoot cases at an early age
- Parent educators (also known as Clinic Assistants) to explain treatment and provide follow up with families, critical for ensuring children complete the treatment process
- Local clinic teams in the use of electronic medical records, data collection, budgeting, strategic planning, program administration and national advocacy for policy change.