Orthopaedic surgeons in Nigeria urge parents of children born with clubfoot to seek early treatment to prevent disability.

According to bone specialists, parents should refrain from attributing clubfoot in children to spiritual causes.

The surgeons emphasize the importance of dispelling myths and misconceptions surrounding clubfoot to ensure all children have access to treatment and reduce social stigma associated with the condition.

Medical experts warn that untreated clubfoot can lead to lifelong disabilities, including pain, walking difficulties, stigmatization, and limited educational and economic opportunities.

The Cleveland Clinic defines clubfoot as a congenital condition where a baby’s foot or feet turn inward.

The clinic reports that approximately one in every 1,000 babies is born with clubfoot, making it one of the more common congenital foot deformities.

Clubfoot happens because of an issue with your child’s tendons, the tissues that connect muscle to bone.

“The tendons in your baby’s leg and foot are shorter and tighter than they should be. That causes the foot to twist. About half of babies with clubfoot have an issue with both feet”, the clinic stated.

According to Nigeria Clubfoot Treatment Partners, an estimated 10,000 children are born with clubfoot in Nigeria every year.

While the exact cause of clubfoot is currently unknown, experts suggest that it could be a combination of genetic and environmental factors, such as a family history of clubfoot, smoking, alcohol consumption, and certain medications taken during pregnancy.

Orthopaedic surgeons emphasize that clubfoot deformity is treatable, with better outcomes seen in children who receive early treatment.

Professor Mike Ogirima, a specialist in Orthopaedic and Trauma Surgery and former President of the Nigerian Medical Association, explains that congenital clubfoot, also referred to as idiopathic clubfoot, is a common abnormality at birth. He notes that the exact cause of idiopathic clubfoot remains uncertain.

Ogirima further states that clubfoot, or talipes equinovarus, can be effectively treated through physical manipulation, highlighting that surgery is no longer necessary due to the success of manipulative treatment strategies.

Additionally, Ogirima, who serves as the Provost of the College of Health Sciences at the Federal University Lokoja, Kogi State, explains,

“In the orthopaedic ward, it is one in 10,000 live births worldwide.  We have two types of clubfoot.

“There is the one we call the congenital type. It is the one that is quoted as being the most common congenital abnormality of the extremities of the foot that is inborn.

“It is also called idiopathic clubfoot because nobody knows the cause but a lot of factors have been associated with it. Those that are developed after birth are called secondary clubfoot or acquired clubfoot, which can be due to foot infection, trauma, and poliomyelitis.”

The orthopaedic surgeon stated that idiopathic clubfoot accounts for around 80 to 90 percent of the cases of clubfoot seen by bone specialists, suggesting that it may have a hereditary component.

He mentioned that acquired clubfoot, caused by factors like accidents or infections, can also be corrected, but the treatment approach should be based on the specific cause of the deformity.

In 2020, the World Health Organization released guidelines aimed at enhancing the quality of care for newborns in healthcare facilities, advising that all newborns should be assessed and managed for congenital conditions.

Providing insight into the treatment of clubfoot and emphasizing the importance of early presentation to orthopaedic surgeons,

the don mentioned, “In the past, a lot of procedures were done, which were not necessary most of the time now,  that is a surgical operation.

“Treatment nowadays is more of a non-operative approach. It just involves physical manipulation. Surgical procedure is no longer necessary.

“Treatment is easier from day one of life and the most common that we offer now, which can offer up to 95 per cent correction of this idiopathic type of clubfoot is what we call the Ponseti.

“So we go by what is called the Ponseti treatment protocol, which involves serial manipulation of all the components of clubfoot.  After four to five weeks (sessions) of manipulations, you should be able to correct it, even the severe form.”

Ogirima highlighted the worrying trend where clubfoot remains stigmatized and shrouded in misconceptions, despite efforts by orthopedic surgeons to raise awareness.

This stigma leads to delayed treatment, resulting in more complex and costly interventions, often requiring surgery.

The orthopaedic surgeon highlighted, “A lot of mysticism has been ascribed to clubfoot in Nigeria but we have come out to disprove that. There is a lot of social stigma associated with the condition.

“When a child is born with clubfoot, their parents will be feeling so guilty that maybe God has punished them for their past sins.

“The issue of witchcraft is also there and that is why up till now, some parents still have that social stigma of coming out with their children who have clubfoot.

“In the past, the traditional bone setters have been patronised in our environment. People go to ask if the deformities are a curse from the demigod or a curse from God as a punishment meted out by God to the family or parents of that child.”

He stated that these misconceptions have deterred many parents from seeking treatment for their children with clubfoot, perpetuating a harmful barrier to care.

“That is why annually now, many non-governmental organisations sponsor their treatment and go to hospitals and train people who will identify them at birth”, he added.

The professor went on to say that they still see adults coming with deformed feet, sometimes on both.

“Now, that one after initial manipulation may be subjected to surgery to get it corrected because of a late presentation. Late presentation is associated with the high cost of treatment.

“So, the earlier a child with clubfoot is presented to the orthopaedic surgeon, the better, the cheaper, and the less strenuous it is with treatment”, he added.

Ogirima urges pregnant women to abstain from folic deficiency as well as alcohol intake, warning that alcohol is very dangerous in pregnancy and could lead to birth defects.

“It can affect the developing child. Then they should avoid radiation exposure and the use of non-prescribed drugs during the first trimester of pregnancy. Even Paracetamol should be avoided as much as possible because nobody knows which drug can cause a defect except the associations that we have seen”, he counselled.

Dr. Peace Amaraegbulam, a Consultant Orthopaedic Surgeon and President of Nigeria Clubfoot Treatment Partners, explained that Clubfoot is a common birth defect that affects the musculoskeletal system, causing the feet to rotate inward and upward, resulting in a deformity.

She emphasized, “In Nigeria, over 10,000 children are born with this condition each year and without treatment, walking becomes extremely difficult and painful as children walk on the sides of their feet.

“This leads to discrimination, social stigmatisation, and loss of economic opportunities.”

Dr. Amaraegbulam emphasized the effectiveness of the Ponseti treatment for clubfoot, but noted that several obstacles prevent many Nigerian children from receiving care, including high out-of-pocket medical costs, limited access to healthcare facilities, a shortage of healthcare professionals, and a lack of specialized foot-abduction braces.