Outcome of Clubfoot Correction at ‘Walk for Life’ Clinic of Mymensingh Medical College Hospital: A Four Year Review

Abstract

Background: Every year in Bangladesh an estimated 3500 - 4000 children are born with a clubfoot deformity, which is approximately one of every 1000 children born in Bangladesh. Left untreated, the condition leads to lifelong deformity causing individual disability and potential unproductivity. Affected children grow up as burden to the family and ultimately leads to significant poverty.
 Methods: This study was conducted at the ‘Walk for Life’ (WFL) clinic Mymensingh Medical College Hospital (MMCH) during February 2011 to December 2014.The non-surgical Ponseti method was applied by the orthopaedic surgeon and physiotherapist. Follow-up for relapsed deformity in children who were treated in 2011 occurred in 2015.
 Results: A total of 577 children comprised of 175 (30.32%) female and 402 (69.7%) male, a gender rati o F: 2.29 M. Completions of treatment data were available for 471 children, as 106 had dropped out at different stages of the treatment cycle. Sadly, 12 children had died. In 440 (76.4%) children, the parents’ monthly income approximated Tk. 5000, and 364 (82.8%) lived in tin shed houses. The parents with lowest incomes predominated for children with clubfoot. Most parents 383(66.4%) were labourers, small business and service workerswith the lowest income. A family history of clubfoot deformity was found in 8.3%, of which 2.8% were cousins, 1.7% were an uncle.The average number of corrective plaster casts applied before the tenotomy was 3.32% in 477 children. In 73.0% of childrenthree to six casts were used for initial correction. An Achilles tenotomy was performed in 81.0% children, 18% did undergo a tenotomy and one child had multiple tenotomies.Four years following of initial treatment, 99 children were reviewed, and 98 were walking and running. Parents’ satisfaction was 96.0%. Thirteen percent children showed relapse signs. Most of the children treated at the WFL clubfoot clinic were walking normally four years after initial treatment.
 Conclusion: The Ponseti method is found to be very effective and especially for a developing country like Bangladesh. Poverty and housing condition may play a role in clubfoot disease. The dropout rate across the treatment cycle was 18.4%, warranting closer evaluation. The patronage of the Glencoe Foundation WFL clinics since 2009, played an important role in relieving thousands of Bangladeshi children from disability.
 Bangladesh Med Res Counc Bull 2018; 44: 132-137