Clubfoot is an embryonic malformation causing a normal foot into becoming clubfoot during the second trimester. An ultrasound may detect it by the 16th week. This abnormality is very common in West African countries and can negatively affect a child’s life, often making them an outcast.
Mercy Ships doctors have initiated the Ponseti Management Program, developed over 50 years ago by Dr. Ignacio Ponseti and used throughout the world to correct Clubfoot. This is the first time it has been used in West Africa.
Dr. James McDaniel, Mercy Ships Ponseti team director began the program a month ago and since then, several children have received castings with positive results.
Baby Anne Akouette, one of a twin, had her first casting less than two weeks after birth. According to Dr. James, "This is the ideal time to start because the bones so easily adapt to the position the cast is reinforcing". He added that, “we’re getting amazing corrections in the older children that we wouldn’t have cast in the past. They would have gone right to surgery.”
This is a favored program because it is gentle, safe, and effective. It requires a minor surgery to allow the Achilles tendon to grow with the foot. Other countries such as Uganda and Brazil now have a national program in place, and are correcting between 90 and 95 per cent of all Clubfoot cases.
The Mercy Ships team is working with the CNAO Clinic and Rehab Center in Lome, training ten members of the clinic's orthopedic team in the Ponseti technique. The training will provide the skills necessary for the clinic's team to further continue the casting progress for those children who have had a series of ponseti manipulations and recastings during this field service. The training will also provide the team with skills to assist others in great need in their nation.
Following the casting, many of the children will need to wear a metal brace which connects to their shoes and meant to be worn at night while sleeping to maintain the correction achieved by casting.
The full cost for the four-year program per patient is one hundred dollars. But here in Africa, this is well beyond what most parents can afford. Casting materials and all other needed supplies for 50 children will be provided by Mercy Ships during the six month field service. It is hoped that funding can be found to keep the clinic supplied with materials for future cases of Clubfoot.
Dr. Frank Haydon, who developed such a brace, is teaching veteran Togolese shoe maker Albert Kpatchou Mawougnan the specifics required in the production of the brace. Albert has been making shoes for problem feet since 1980, when a local lawyer asked him to make an experimental pair for his child. Orthopedist Heabe Raiz, who has been with the clinic for four years, is taking a leading role in the Ponseti procedure and the proper use of the brace.