A 2‑Year Review of the Rotary‑Supported Ponseti Clubfoot Clinic in Lagos, Nigeria
Keywords:
Congenital clubfoot, foot abduction braces, ponseti methodAbstract
Background: The Ponseti method is generally acknowledged to be the gold standard for congenital clubfoot treatment, worldwide. Although this treatment is considered to be cheap and effective, some patients in less affluent climes are unable to afford the treatment, which includes wearing of braces until the age of 4 years. Objectives: This study documents the experience of running a clubfoot clinic with the financial support from three rotary clubs for 2 years and aims to review the impact of the sponsorship and recommend a replication of this model in similar settings. Materials and Methods: This is a retrospective study of patients treated in our clubfoot clinic adopted by the rotary clubs from 20th September 2017 to 20th August 2019. Age at presentation, sex, laterality, Pirani score, number of casts to correction, brace compliance and complications were recorded prospectively in the International Clubfoot Registry hosted by The Center for Bioinformatics and Computational Biology at the University of Iowa, USA, and analysed using Microsoft Excel software. Results: A total of 136 patients were treated, 81 (60%) of which had bilateral deformities, totalling 217 feet. There were 71 males and 65 females, with a male‑to‑female ratio of 1:0.9. The age at first visit ranged from 0 to 10 years. The largest number, 74 patients (54.4%), was aged between 0 and 3 months, but only one was aged above 10 years, at presentation. Using the Pirani score, 71% had severe deformities (Pirani score of 4 and above). The tenotomy rate was 29%. The average number of casts to correction was 4.6. Sixty‑eight patients received braces at subsidised rates of 50% of the cost. Only 5% of the feet relapsed after correction. Conclusion: The rotary club intervention in our clubfoot clinic was associated with an increase in the annual number of patients attending the clinic, but the relapse rates remained the same as with previous studies.
References
1. Adewole OA, Giwa SO, Kayode MO, Shoga MO, Balogun RA. Congenital club foot in a teaching hospital in Lagos, Nigeria. Afr J MedMed Sci 2009;38:203‑6.
2. Omololu B, Ogunlade SO, Alonge TO. Pattern of congenitalorthopaedic malformations in an African teaching hospital. West Afr JMed 2005;24:92‑5.
3. Wynne‑Davies R. Genetic and environmental factors in the etiology oftalipes equinovarus. Clin Orthop Relat Res 1972;84:9‑13.
4. Ukoha U, Egwu OA, Okafor IJ, Ogugua PC, Udemezue OO, Olisah R,et al. Incidence of congenital talipes equinovarus among children insoutheast Nigeria. Int J Biol Med Res. 2011;2:712-5. Available form:https://www.biomedscidirect.com/journalfiles/IJBMRF2011278/incidence_of_congenital_talipes_equinovarus_among_children_in_southeast_nigeria.pdf. [Last accessed on 2019 Oct 15].
5. Irani RN, Sherman MS. The pathological anatomy of idiopathicclubfoot. Clin Orthop Relat Res 1972;84:14‑20.
6. Jowett CR, Morcuende JA, Ramachandran M. Management ofcongenital talipes equinovarus using the Ponseti method: A systematicreview. J Bone Joint Surg Br 2011;93:1160‑4.
7. Cooper DM, Dietz FR. Treatment of idiopathic clubfoot. A thirty‑yearfollow‑up note. J Bone Joint Surg Am 1995;77:1477‑89.
8. Ponseti IV (Ignacio V. Congenital Clubfoot: Fundamentals of Treatment. Oxford University Press; 1996. Available from: https://books.google. co.uk/books/about/Congenital_Clubfoot.html?id=oLNsAAAAMAAJand redir_esc=y. [Last accessed on 2019 Oct 15]9. Laaveg SJ, Ponseti IV. Long‑term results of treatment of congenital clubfoot. J Bone Joint Surg Am 1980;62:23‑31.
10. Morcuende JA, Abbasi D, Dolan LA, Ponseti IV. Results of an acceleratedPonseti protocol for clubfoot. J Pediatr Orthop 2005;25:623‑6.
11. Elgohary HS, Abulsaad M. Traditional and accelerated Ponseti technique:A comparative study. Eur J Orthop Surg Traumatol 2015;25:949‑53.
12. Tindall AJ, Steinlechner CW, Lavy CB, Mannion S, Mkandawire N. Results of manipulation of idiopathic clubfoot deformity in Malawiby orthopaedic clinical officers using the Ponseti method: A realisticalternative for the developing world? J Pediatr Orthop 2005;25:627‑9.
13. Gupta A, Singh S, Patel P, Patel J, Varshney MK. Evaluation of the utilityof the Ponseti method of correction of clubfoot deformity in a developingnation. Int Orthop 2008;32:75-9. doi:10.1007/s00264-006-0284-7.
14. Shack N, Eastwood DM. Early results of a physiotherapist‑deliveredPonseti service for the management of idiopathic congenital talipesequinovarus foot deformity. J Bone Joint Surg Br 2006;88:1085‑9.
15. Mejabi JO, Esan O, Adegbehingbe OO, Orimolade EA, Asuquo J,Badmus HD, et al. The Pirani Scoring System is Effective in AssessingSeverity and Monitoring Treatment of Clubfeet in Children. Br J MedMed Res 2016;17:1-9. Available from: http://www.journaljammr.com/index.php/JAMMR/article/view/10763/19400. [Last accessed on 2019Nov 01].
16. Hussain FN. The role of the Pirani scoring system in the management ofclub foot by the Ponseti method. J Bone Joint Surg Br 2007;89:561.
17. Dyer PJ, Davis N. The role of the Pirani scoring system in themanagement of club foot by the Ponseti method. J Bone Joint Surg Br2006;88:1082‑4.
18. Adewole O, Williams O, Kayode M, Shoga M, Giwa S. EarlyExperience with Ponseti Club Foot Management in Lagos, Nigeria. East Cent African J Surg 2014;19:72‑77. Available from: https://www. ajol.info/index.php/ecajs/article/view/107768/97610. [Last accessed on2019 Oct 15].
19. Pirani S, Naddumba E, Mathias R, Konde‑Lule J, Penny JN, Beyeza T,et al. Towards effective Ponseti clubfoot care: The Uganda SustainableClubfoot Care Project. Clin Orthop Relat Res 2009;467:1154‑63.
20. Global Affairs Canada. Global Affairs Canada. Available from: https://www.international.gc.ca/gac‑amc/index.aspx?lang=eng. [Last accessedon 2019 Oct 15].
21. Canadian International Development Agency. University Partnershipsin Cooperation and Development Program Evaluation; 2007. Availablefrom: http://www.oecd.org/derec/canada/40690638.pdf. [Last accessedon 2019 Oct 15].
22. CBM International. Welcome to the CBM website! | Start here. Availablefrom: https://www.cbm.org/. [Last accessed on 2019 October 15].
23. Dobbs MB, Rudzki JR, Purcell DB, Walton T, Porter KR, Gurnett CA. Factors predictive of outcome after use of the Ponseti method for thetreatment of idiopathic clubfeet. J Bone Joint Surg Am 2004;86:22‑7.
24. Ponseti IV. Treatment of congenital club foot. J Bone Joint Surg Am1992;74:448‑54.
25. Ponseti IV. Common errors in the treatment of congenital clubfoot. IntOrthop 1997;21:137‑41.
26. Spiegel DA, Shrestha OP, Sitoula P, Rajbhandary T, Bijukachhe B,Banskota AK. Ponseti method for untreated idiopathic clubfeet inNepalese patients from 1 to 6 years of age. Clin Orthop Relat Res2009;467:1164‑70.
27. Khan SA, Kumar A. Ponseti’s manipulation in neglected clubfoot inchildren more than 7 years of age: A prospective evaluation of 25 feetwith long‑term follow‑up. J Pediatr Orthop B 2010;19:385‑9.
28. Grimes CE, Holmer H, Maraka J, Ayana B, Hansen L, Lavy CB. Cost‑effectiveness of club‑foot treatment in low‑income andmiddle‑income countries by the Ponseti method. BMJ Glob Health2016;1:e000023.
29. Hussain H, Burfat AM, Samad L, Jawed F, Chinoy MA, Khan MA. Cost‑effectiveness of the Ponseti method for treatment of clubfoot inPakistan. World J Surg 2014;38:2217‑22.
Downloads
Published
Issue
Section
License
Copyright (c) 2019 Oladipo A. Adewole, Matthias O. Shoga, Omolara M. Williams, Olawale S. Famude, Michael O. Kayode, Samuel O. Idowu (Author)
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors publishing in the Nigerian Journal of Orthopaedics and Trauma retain the copyright to their work.
All articles are published under the Creative Commons Attribution 4.0 International (CC BY 4.0) licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
