The Bangladesh clubfoot project: audit of 2-year outcomes of Ponseti treatment in 400 children.
BACKGROUND
Congenital clubfoot deformity can cause significant disability, and if left untreated, may further impoverish those in developing countries, like Bangladesh. The Ponseti method has been strategically introduced in Bangladesh by a nongovernment organization, Walk For Life (WFL). WFL has provided free treatment for over 8000 Bangladeshi children with clubfeet, sustained by local ownership, and international support. This audit assesses the 2-year results in children for whom treatment began before the age of 3 years.


METHODS
The 10 largest WFL clinics, of the 24 across Bangladesh, were pragmatically accessed in this audit availing 1442 subjects meeting the study criteria, from which 400 children were randomly selected and examined. A specific assessment tool was developed and validated.


RESULTS
Results for 400 cases were returned: 269 males, 131 females. Typical clubfeet comprised 79% of cases, and 55% were bilateral. A tenotomy rate of 79%, and brace use after 2 years of 85%, were notable findings. Functionally, most children could walk independently (99.0%), run (95.5%), squat (93.3%), and manage steps unassisted (93.0%). The ability to squat was the most indicative outcome measure, correlating with: less corrective casts, good and continued brace use, nonvarus heel position, good ankle range of motion, good Bangla clubfoot scores, and the ability to walk. Relapsing deformity was suspected with heel varus (18.0% left; 21.5% right). Parental satisfaction was very high, but cost of 3000 Taka ($US 38.48) was deemed unaffordable by 59%.


CONCLUSIONS
The outcomes in young children after 2 years of Ponseti treatment for clubfoot deformity showed that 99% were able to walk independently. The assessment tool developed for this study avails ongoing monitoring. Without the patronage of WFL, most of these children would not have had access to treatment, and be unable to walk.


METHODS
Level II-lesser-quality prospective study.
*Clinical Services, Walk For Life, Dhaka §Walk For Life Ponseti, LAMB Project, Rajabashor, Parbatipur, Dinajpur, Bangladesh †Walk For Life, Department of Podiatry, Lower Extremity and Gait Studies (LEGS) Research Program, La Trobe University, Bundoora, Melbourne, Vic., Australia ‡Health and Rehabilitation Research Institute, AUT University, Auckland, New Zealand ∥Department of Orthopaedic Surgery, University of Iowa, Iowa City, IA ¶Department of Paediatric Orthopaedic Surgery, Royal Aberdeen Childrens Hospital, Aberdeen, UK.
Roksana
R
Perveen
Angela M
AM
Evans
Vikki
V
Ford-Powell
Frederick R
FR
Dietz
Simon
S
Barker
Paul W
PW
Wade
Shariful I
SI
Khan
D000843:Ankle Joint / Q000503:physiopathology*; D001459:Bangladesh; D002370:Casts, Surgical; D002675:Child, Preschool; D054869:Clinical Audit; D003025:Clubfoot / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008349:Manipulation, Orthopedic / Q000379:methods*; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D058971:Tenotomy / Q000379:methods*; D016896:Treatment Outcome