Clubfoot Awareness – Cure India

Every year, around 40,000 children in India are born with clubfoot, a condition where one or both feet turn inward.
In this film Santosh brings to us the global context of clubfoot, and then through Dr. Mathew Varghese, one of India’s foremost orthopedic surgeons and a leading authority on clubfoot, we gain a clear understanding of the condition – what it is, why it happens, and how it can be fully treated.
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So, the guesstimate is around 40,000 children are born with a clubfoot in India every year.
And in 2008, we did a study to understand why many children are not getting treated.
And we realized there are few things, one: training for doctors, second: there is a special shoe that is required for the children, third: this requires a long term rehabilitation with special shoe, and then fourth: the documentation was not so strong in the government hospitals.
So, to fill this gap, a program was started.
These are all the centers we have across India, we have 442 centers.
These are all government medical colleges and government hospitals.
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Clubfoot is a condition which the child is born with, born with, does not acquire, born with a deformity of the foot which causes the foot, normal foot is pointing forward.
This causes the foot to turn in and like that.
So, what does this look like?
This looks like a golf club.
So, it looks down, down and in and turned in like that.
So, that’s like a club of golf, it is present from birth.
80 to 85 percent of this, the child will have no other problem except for this foot deformity.
present from birth.
About 40 percent of them have both their feet turned in like that, rest have only one foot turned in like that.
The typical idiopathic club foot.
So, the term idiopathic is used by doctors for conditions where they will find no other reason for it, only one problem and nothing else is there.
So, 80 to 85 percent are idiopathic clubfoot.
Is it genetic?
No.
However, sometime during the course of the growth of the baby in the mother’s womb, it becomes bent.
So, can you diagnose it in the first three months of pregnancy?
No.
Can you diagnose it afterwards?
Somewhere between 14 to 16 weeks, the ultrasound will show it.
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My child’s name is Arav and I am Sweety.
He is 1 year and 2 months old.
Arav’s leg was bent from the time he was in the womb.
I began his treatment – the first step was getting his leg plastered, then ‘cheera’ or a cut was made, then he wore the shoes and now his treatment is going well.
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So, parents come to me, ultrasound diagnosis of clubfoot, should we terminate the pregnancy?
So, I said come quickly, don’t delay, I will talk to you.
So, the doctor’s job is to see, the ultrasound report will have several details to it.
So, the doctor’s job is to see, is it with no other anomaly or is it just clubfoot?
If it is just clubfoot, idiopathic, you can treat it completely, child walking normally, running normally, playing normally, doing everything normally.
So, when we talk about treatment by Ponseti’s method, the most effective method for idiopathic clubfoot.
Earlier they start the treatment, the better it is.
The treatment is simple by a plaster technique, not by surgery, but by casting.
So, this technique, the Ponseti’s method, is unique.
It’s a non-surgical technique by serial plastering, which is not below the knee, which is not middle of the thigh, from the groin of the child to the toes.
It’s a long plaster with the knee held like this, 90 degrees.
And each time what we do, we do, the doctor does a manipulation, so, it’s like this, it’s not straight, this foot is not straight, it’s been partially corrected.
So, we do the manipulation and see this and I do this.
And each time I keep correcting it, now it looks better.
So, that’s what we do, manipulation and serial casting
So, right from the time the child comes, you start it.
So, how often do you cast it?
Every week.
So, each week, a little more correction, each week a little more.
So, to start with, it is like this.
Second plaster it’s like this.
Third plaster it’s like this.
Fourth plaster it’s almost straight.
By fifth plaster, it starts going out.
Then the deformity which is causing the heel to be up, equinus, the word equine, equestrian sport comes from horses, so, equine is, the horses walk on their hooves, so, these children, if uncorrected, they will walk on their toes, equine.
So, that equinus is corrected by a small surgical procedure.
That’s never corrected with plastering.
There is small surgical procedure, we do a small surgery here, it’s a stitchless surgery done under local anesthesia, can be done anywhere, in the OPD I do it, in a minor OT or in the theatre, but important thing is under local anesthesia, a small incision and a small cut, that dramatically corrects the foot to go up.
Once tenotomy is done, the foot goes up completely straight.
This cast is retained for three weeks.
For three weeks, once the three weeks are over, the sixth cast, that is three weeks are over, then the child is ready for a brace.
The surgery ordeal is over.
After three weeks of surgery, the child has the foot looking normal.
But this normal looking foot has a nasty tendency to go back into the deformed position.
That needs to be prevented, which is done by this brace.
And the brace is unique.
It has the feet turned out 70 degree.
Parents are worrying, no, both feet are tied together, 70 degree.
There is no other way, it can be maintained in the corrected position except by this brace.
First 3 months, 23 hours a day.
Yes, the doctor recommended doing exercises with my child for half an hour each in the morning and evening.
Yes, that’s what they explained, and that the shoes must be worn for 23 hours a day.
Did they prescribe any medicines?
No, no medicines were given.
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After 3 months, the child has to have the brace during the sleeping period of the child, night time or day time.
The child has to be in a brace, night time and nap time.
We tell them, as long as the sleep is on, the brace is on.
How long?
Till the baby is 5 years.
So the child has to understand the brace is important.
Parents have to understand brace is important.
The grandparents have to understand.
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We noticed it right when he was born,that his foot was bent.
So we took him to Meerut, there, they put on plaster casts, five times, then the cut was made and they gave us the shoes.
Then his foot got infected and we couldn’t make him wear the shoes regularly, though it had become straight then, it has started bending again.
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Children, best despite their trying to get the brace out, the deformity will come back, so, many doctors advise surgery after that.
No – it can again be corrected by Ponseti’s method.
So, recurrences can be treated without surgery.
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Awareness on clubfoot is the biggest challenge.
Many parents think their child was born with polio.
Clubfoot is not polio.
Clubfoot is always by birth, whereas polio is after birth.
Polio, we know the reason, so that’s why we could prevent, we could stop.
Whereas clubfoot, we do not know the reason.
So, we cannot blame father, mother, family for child being born with clubfoot.
For every 800 live birth, one child is born with a clubfoot and till today we do not know the reason.