1. Introduction PM1
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Transcript of 1. Introduction PM1
Introduction To Clubfoot
Dr. E KOMBO
What is clubfoot?
• ‘Congenital deformity of the foot that feels fixed’
• Congenital Talipes Equinovarus (CTEV)
Clubfoot Etiology
• Most often idiopathic• Less commonly
secondary• Not understood clearly• Definite hereditary
influence– NOT related to mother’s
behaviour
Epidemiology
• Incidence – Incidence – 0.6-8/1000 live births (average 1.2/1000)
• Prevalence – higher in low and middle income countries
• Global epidemiology – approximately 200,000 new cases per year, 80% in low and middle income countries.
• More common in boys: 2:1 male: female• 40% of cases bilateral
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Worldwide: 200,000+
Annual Newborns with Clubfoot
Consequences of clubfoot• Idiopathic clubfoot: most
common congenital orthopaedic condition causing locomotor disability.
• Neglected clubfoot results in severe disability and stigma
• As the foot is walked on the deformity worsens
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Consequences of untreated clubfoot
• Cosmetic - permanent deformity
• Pain• Inability to wear normal
footwear• Stigma and discrimination
– difficulty in access– difficulty in gaining
education/employment– Less likely to marry
• Other social consequences - abandonment, begging
• Consequences for the individual, their family and society
Why so much neglected clubfoot?
• Lack of awareness• Condition not
diagnosed / treated early• Lack of treatment
facilities• Ineffective treatment
Clubfoot in [country]
• Number of children born per year with clubfoot: [###]
• Group discussion and feedback:– What methods of treatment are currently being
used for clubfoot in this country?– How well are these working?– What are the challenges of providing treatment for
clubfoot in this country?
Clubfoot treatment options
• Surgical techniques
• Conservative techniques – Kite, French methods
• Other – Ilizarov frames, Thomas wrench
• Ponseti technique
Treatment options: Ponseti technique
• The Ponseti technique: Dr Ponseti (1960s): – A very specific treatment protocol of:– manipulation, casting, tenotomy and bracing.
• ‘Gold Standard’ for clubfoot treatment
• Using the Ponseti technique we have the opportunity to prevent disability and change a child’s life!
Clubfoot treatment: public health perspective
• Easy• Efficient• Effective• Economical
CURE Clubfoot Worldwide (CCW)• Part of CURE International, paediatric orthopaedic non-profit
organisation
• Has programmes for clubfoot in 16 countries worldwide (2011)
• CCW works to establish and support national programmes for clubfoot:– Train local health workers in Ponseti management– Raise awareness about clubfoot– Provide funding for children who cannot afford treatment
A national programme for clubfoot in [country]
• [Add details here of the national clubfoot, partner organisations including CCW etc]
• Today YOU are part of a national and international programme to make the lives of children with clubfoot better!
• Web-based group for sharing resources and training materials for organisations and individuals working with children with clubfoot in low and middle income countries
• www.globalclubfoot.org
• Collaborative partnership between organisations• CURE Clubfoot Worldwide, ALTSO, CBM International,
Feetfirst, Handicap International, Prosthetics Outreach Foundation, Walk for Life and many more
Acknowledgements• Development of these training materials was funded by CURE Clubfoot Worldwide
and we thank everyone involved especially those who volunteered their time and resources to help.
• Andy Mayo (CURE Clubfoot Worldwide, Miraclefeet) - for starting it all off• Jim Cohick (CURE Clubfoot Worldwide) – for coordinating the project• Rosalind Owen (Global Clubfoot Initiative) and Dr Norgrove Penny (CBM
International) – for editing the materials
• Reviewers:• Dr Bob Cady (USA, Haiti)• Dr Fred Dietz (USA, Bangladesh, Laos)• Linda Hansen (Australia, Kenya)• Professor Chris Lavy (UK, Malawi)• Iris Lohan (China)• Dr Norgrove Penny (Canada, Uganda)• Michiel Steenbeek (Netherlands, Uganda)
We would like to acknowledge the people who contributed material and images for this curriculum:
Winfried DankeNaomi Davis MB BChFred Dietz MDMatthew Dobbs MDVikas Gupta MDJohn Herzenberg MDChris Lavy MDIris LohanColin MacFarlaneSteve Mannion MB, BChJennifer McCahillJosé Morcuende MD
Vince Mosca MDMonica Noguiera MDRosalind OwenNorgrove Penny MDShafique Pirani MDIgnacio Ponseti MDDavid Scher MDMarc Sinclair MDDavid Spiegel MDLynn Staheli MDMichiel Steenbeek