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The Haitian Clubfoot Project By Patrick A. DeHeer, DPM
Purpose: To treat and cure clubfoot deformity in Haitian infants less than 2 years old with the Ponseti method of non-surgical clubfoot treatment.
Demographics: Based on census population results, birth rates for 2003 and the rate of occurrence of clubfoot deformity in Caucasians (1/1000), Malawi (2/1000) and South African Blacks (3/1000), there will be approximately 300 to 700 Haitian babies born with clubfoot deformity annually.[i][ii]
Need to Treat: Clubfoot is the most common congenital cause of locomotor disability in the developing world.2 Due to a limited number of surgeons and facilities in developing countries, the majority of these cases are either neglected or inadequately treated. The effect of the neglected or recurrent clubfoot on quality of life is severe in developing countries. The result is limited ability to ambulate with dependency for daily activities which produces significant economic impact on a country that is the 3rd poorest country in the world and poorest in the western hemisphere.[iii] 1It is also well documented that children with clubfoot are associated with considerable social stigma and less likely to receive an education.3 Girls in particular are even more so affected due to a higher incidence of physical and sexual abuse with the disability.3
What is the Ponseti Method of Clubfoot Treatment: This technique consists of serial manipulations and casting of the clubfoot. Typical course of therapy consists of 5 castings followed by bracing to maintain the correction up to the age of three. Approximately 80-85% of the patients require an Achilles tendon release which is done in the clinic setting under a small amount of local anesthetic to correct the final aspect of the clubfoot. The 5th cast maintains this final position for three weeks. The bracing aspect is then initiated. The Ponseti method of correction has been used for over 50 years to correct clubfoot deformity and has replaced the older, less reliable Kite’s method of casting. When the Ponseti method is done correctly, the extensive posterior medial release surgery on infants is rarely required.
Results of the Ponseti Method: 1. Long term study by Cooper and Diez reported 78% good and excellent results at a minimum follow-up of 25 years.[iv]
2. The Uganda Clubfoot project had a 96.7% success rate in 176 children with 182 clubfeet over a 3 year period of time.[v]
3. Several other areas have instituted a similar protocol to the Uganda Project and shown likewise results: Sao Paulo, Brazil Hamburg, Germany Vancouver, BC Ahmedabad, India Manchester, UK Seattle, US Baltimore, US Lyon, France Rome, Italy Barcelona, Spain Goteborg, Sweden5
Why Not Surgery: Early and even initial surgical procedures instead of casting have been advocated in the past due to the under-corrected, recurrent or over-corrected deformities using the traditional Kite’s method of casting. These surgical procedures have led to several documented failures and significant complications.[vi]
Haitian Clubfoot Project Members: Patrick A. DeHeer, DPM - Project Medical Director (padeheer@sbcglobal.net) The Timmy Foundation - www.timmyfoundation.org/ The Haitian Academy - www.haitianacademy.net/school/history.htm Course of Action: Identify approximately 5 infants less than 2 years of age to start treatment on while simultaneously training 1 or 2 Haitian doctors in the Ponseti method. Dr. DeHeer would travel to Haiti five consecutive weekends for this treatment and training initial stage of the Haitian Clubfoot Project at the Haitian Academy Medical Center. Supplies, post-casting bracing, travel expenses, and training/educational material would be funded by tax-deductible donations through the Timmy Foundation. Once a center is established, other regional centers would be opened with 2 day training seminars held in Haiti. On-going documentation and supervision of the medical portion of this project would be the responsibility of the Project Medical Director. Surgical correction of resistant cases and the arrangements of such cases will be determined. The post-casting braces ideally will be made locally in Haiti by training a local artisan to make similar braces to those used in the Uganda Project.
How Can You Help: Tax-deductible donations can be made directly to the Timmy Foundation. In the memo section of the check please write HCP as the Timmy Foundations supports several different projects. 100 % of your donation will go directly to the Haitian Clubfoot Project.
Timmy Foundation 6101 N Keystone Avenue
[ii] Ponseti, I.V. (2000). Congenital Clubfoot Fundamentals of Treatment. Oxford Medical Publications, New York. [iii] Penny, N.J. The Ponseti Method of Clubfoot Care: A vision for the developing world. [iv] Cooper, D.M. and Dietz, F.R. (1995). Treatment of idiopathic clubfoot. A thirty-year follow-up. J Bone Joint Surg. (AM.), 77A. [vi] Morcuende, J.A., Weinstein, S.L., Dietz, F.R., Ponseti, I.V. (1994). Plaster cast treatment of clubfoot: The Ponseti method of manipulation and casting. J Pediatr Orhop Part B, Vol 3, No. 2.
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