Global clubfoot treatment in 2023: an overview of advances and outcomes.

Abstract

Introduction: Approximately 200 000 children are born each year with clubfoot, the majority of whom live in low-income and middle-income countries (LMICs). If untreated, clubfoot causes pain and reduced mobility, leading to activity limitations and disability. The Ponseti method is a highly effective and minimally invasive treatment. This observational study aims to quantify the countries providing clubfoot services and the children receiving treatment in 2023 and compares progress since data were first collected in 2005.

Methods: In January and February 2024, data on clubfoot treatment in 2023 were collected from 70 countries. Informants completed a survey about new cases enrolled, treatment outcomes and health system integration. Data were analysed using descriptive statistics, with adjustments made for duplicates, and included clinic locations, the number and ages of children starting treatment, types of support available and Ministry of Health involvement. We compared coverage trends over time and used a cartogram to visualise the extent of clubfoot programme coverage across countries.

Results: Responding countries accounted for 83% of all expected cases in LMICs. There was an increase in enrolment numbers, to 40 382, in 2023. Despite this progress, treatment coverage remained low at approximately 22% across respondent countries. While integration of clubfoot services into national healthcare systems varied widely, strong public-private partnerships in many countries suggest a foundation for sustainable, long-term treatment programmes. However, quality care remained a challenge, with only 67% of children receiving their first foot abduction brace, indicating gaps in ensuring comprehensive treatment necessary for successful clubfoot management. Lingering effects of COVID-19 restrictions include a higher percentage of cases enrolled after 1 year of age.

Conclusions: A larger proportion of children in LMICs received Ponseti treatment in 2023 compared with 2005. However, more work is needed to expand national programmes, build sustainable, high-quality treatment capacity and ensure all children get the care they need to avoid lifelong disability.