Abstract

Background: Children with untreated clubfeet (CTEV) aged one year or older are usually walking on grossly deformed feet. Typically, they have been regarded as being ‘too old’ for treatment with the ‘gold standard’ Ponseti method. These children will rarely receive surgical correction, associated with poorer long-term results, and have a high probability of remaining disabled and impoverished for life. Treatment of older children with Ponseti method has been reported, and this case series shows the possible and positive outcomes in 10 Bangladeshi children, with minor modification of the original Ponseti method.

Aims: This case series aimed to report the results of treatment of neglected clubfoot in older children in rural Bangladesh, with follow up extended to eight years

Methods: Ten children with untreated/neglected clubfeet aged between 1-11 years were availed a modified Ponseti method treatment by a WFL physiotherapist in a rural region of Bangladesh.

Results: All children had functioning feet enabling them to walk, and had disabled lives transformed with application of low-cost treatment beginning at a later age. More resources were required (plaster bandage) for the longer legs, but compliance was enhanced by children’s understanding and desire for correction. Pictorial posters were aspirational for both the parents and children.

Conclusion: WFL has successfully treated over 25,000 babies and young children with CTEV since 2009. The results of treating neglected cases in Bangladesh have not been previously recorded. Whilst treatment for CTEV is ideally commenced prior to six months of age, neglected CTEV in older children should be managed with Ponseti method principles as a first line approach. Full correction may be achieved at low cost and low risk.

Keywords: Neglect; Ponseti; Clubfoot; Outcomes