Expert advocates adoption of Ponseti method in treatment of clubfoot deformities

A leading Nigerian Clubfoot Doctor and an expert in Clubfoot deformities management, Prof. Olayinka Adegbehingbe, has advocated for the adoption of Ponseti method; a manipulative technique that corrects congenital clubfoot without invasive surgery in the treatment of all congenital clubfoot cases in the country.

Adegbehingbe while recommending the Ponseti Clubfoot Treatment for adoption and use by health facilities in the country at a ceremony held over the weekend to commemorate the year 2016 World Clubfoot Day Celebration in Nigeria, stated that Clubfoot is a worldwide synonym for Talipes Equinovarus, a congenital limb deformity that has added to the burdens of families and communities.

The expert who is also the National Coordinator, Nigerian Sustainable Childcare Clubfoot Programme and Ponseti Clubfoot Foundation noted that the congenital deformity affects almost 150,000 children annually stressing that almost 80 per cent of these children live in developing nations, Nigeria inclusive.

Adegbehingbe stated that the need for management of this condition without invasive surgery has necessitated the adoption of the Ponseti method of treatment, which is a low-cost, low technology, non-invasive method of clubfoot treatment that is known to have recorded excellent success rate globally.

He further stated: “The Ponseti’s technique is painless, fast, cost-effective and successful in almost 100 per cent of all congenital clubfoot cases and it is endorsed and supported by World Health Organization (WHO).”

Adegbehingbe added that the goal of the Ponseti method of treatment is functional, pain-free, plantigrade foot, with good mobility and without calluses, and patient does not need to wear modified shoes.

Explaining how the Ponseti method of treatment is used to correct clubfoot deformity, the National Coordinator, Nigerian Sustainable Childcare Clubfoot Programme and Ponseti Clubfoot Foundation stated that the manipulative treatment of clubfoot deformity is based on the inherent properties of the connective tissue, cartilage, and bone, which respond to the proper mechanical stimuli created by the gradual reduction of the deformity.

He added that the ligaments, joint capsules, and tendons are stretched under gentle manipulations and a plaster cast is applied after each manipulation to retain the degree of correction and soften the ligaments. He said that the displaced bones are thus gradually brought into the correct alignment with their joint surfaces progressively remodeled yet maintaining congruency.

“After two months of manipulation and casting, the foot appears slightly over-corrected but after a few weeks in splints however, the foot looks normal,” Adegbehingbe said.

He posited that proper foot manipulations require a thorough understanding of the anatomy and kinematics of the normal foot and of the deviations of the tarsal bones in the clubfoot stressing that poorly conducted manipulations will further complicate the clubfoot deformity.

“The non-operative treatment will succeed better if it is started a few days or weeks after birth and if the podiatrist understands the nature of the deformity and possesses manipulative skill and expertise in plaster-cast applications,” Adegbehingbe noted.

He stated that treatment of clubfoot deformity occurs in clubfoot clinical units, which consist of the personnel, infrastructure, and specialized activities that support outpatient treatment of clubfoot deformity using the Ponseti method.

“The Ponseti method for clubfoot treatment is available in 32 states in Nigeria and the Federal capital Tertitory, Abuja and this method is also endorsed and supported by the American Academy of Orthopaedic Surgeons (AAOS); the Nigerian Orthopaedic Association (NOA) and Federal Ministry of Health,” Adegbehingbe said.

He noted that a National Guideline on Clubfoot Management has been developed has part of effort to implement the strategy of reducing long-term effects of this condition adding that the guideline is practical, easy to use, and very rich in scientific information.

“This guideline on clubfoot management will be very useful to all those involved in clubfoot detection, management and rehabilitation programs, especially parents, doctors, physiotherapists, orthotics, orthopaedic technicians, nurses, and midwives and other stakeholders. This Ponseti method management text has been translated into three Nigerian languages; Hausa, Yoruba and Igbo languages,” he noted.

Adegbehingbe solicited for the support all stakeholders especially the media is to help sensitize the public to overcome myths and misunderstandings about the causes of clubfoot deformity and to identify treatment centers/locations nearest to a clubfoot victim.

He called on parents and caregivers of clubfoot patients to aggressively seek qualified Ponseti healthcare practitioners at different treatment facilities across Nigeria for the treatment of all congenital clubfoot cases.

The Coordinator of Nigerian and West African Clubfoot Study Group also admonished operators and managers of Health Facilities in Nigeria to adopt the use of the Ponseti method in the treatment of Clubfoot deformities stressing that it has been proven that the technique is painless, fast, cost-effective and successful in almost 100 per cent of all congenital clubfoot cases.

“This year’s World Clubfoot Day Celebration with the theme, ‘Clubfoot Disability: Breaking the Barriers’ marks the 4th year of celebration of the World Clubfoot Day which is held yearly on the 3rd of June. We celebrate the day with all clubfooted-babies treated and yet to be treated in Nigeria,” Adegbehingbe stated.