By Lominda Afedraru

It is early morning hours at exactly 7:00 am as I catch up with the Motor cycle man commonly known as (Boda Boda) to take me to Uganda’s referral Mulago Hospital to interview experts and beneficiaries whose children’s feet have been corrected against Club Foot.

Since it was the day to run the clinic for patients particularly babies born with clubfoot ailment, it was easy to talk to one of the mothers whose baby was already recovering since the medical team are so willing to help.

Speaking to the Principal Orthopedics Clinical officer Diriisa Kitemagwa at Mulago Hospital, he defines Club foot as one of the commonest congenital abnormalities in children who are born with bent foot like a club.

The condition can be corrected if brought to medical attention immediately the child is born, otherwise if neglected it may lead to eternal abnormality of the foot causing someone to be lame.

The story of the successful mother

Mr Kitemagwa was quick to introduce the writer to one of the mothers whose child’s leg has been corrected and she is filled with joy.

“”My name is Anita Namutebi a resident of Salama Road village in Munyonyo aged 29 years. I am a mother to three children, the two were born normally with no problem but I gave birth to my 7 month old baby with club foot on both legs. I am so glad that both legs are now fine,” She narrates.

According to her when she gave birth to her baby girl Doreen Kasaga, her husband Mr Dan Kasaga was very supportive. This is after one of her brothers advised her to take the child to Mulago Hospital in order for the feet to be corrected.

According to Namutembi, she gave birth in a clinic located in Salama Road village, a Kampala suburb. However she took the child to Mulago hospital for medical attention when she was two months.

“I was somehow traumatized that my baby will grow up with deformed feet, but my husband and my biological brother were very supportive. We went to the hospital and they accompanied me. The medical workers at the clubfoot clinical facility were equally very supportive. We found a number of mothers with children who had club foot and this alone consoled me,” She narrates.

She explained that the medical workers carried out a simple surgery on both feet which were clustered and after three months the clusters were removed. She was given shoes which the baby must put on in order for the legs to get corrected.

As a successful mother, she is encouraging mothers who deliver babies with such condition to take them to any referral hospital especially Mulago hospital where the services are free of charge.

Another mother Isha Omia aged 24, a resident of Nakulabye a Kampala suburb who brought her 9 month old baby boy to the same clinic was equally happy because her child’s feet were already corrected.

She was a little shy to speak about the challenge, since this was her first born. She however narrated that she gave birth in a nearby clinic near her residence and immediately she noticed her babies legs were clubbed, she went seeking information about it at Mulago Hospital in the Orthopeadics section.

She talked to one of the nurses who advised her to come on a Thursdays when the club foot clinic usually operates. This is what she did when the baby was actually three weeks old

She is now a happy mother and she is optimistic that her next baby will not have such a challenge.  She praised the medical team for the tremendous work done to all babies who are born with club foot.

The background of club foot existence in Uganda

Dr Mallon Nyati, a consultant in orthopedics surgery department from Mulago Hospital explains that there are various types of club foot with the congenital being the most common serious birth defect.

Citing the statistics from a book published in 2008 by a team of experts dealing in correcting club foot in children titled “Ponseti Club foot management” he notes that more than fifteen hundred children were born with club foot in Uganda each year. The number may have dropped given the current awareness about it.

He notes that Clubfoot can occur either in one or both feet. It can range from mild to severe. In 1994, there were an estimated 10,000 neglected cases of club foot in Uganda.

The experts state that club foot if left untreated will make the foot to remain twisted inwards and it becomes painful.

According to Dr Nyati, Uganda’s Ministry of Health in the year 2008 started Uganda’s sustainable clubfoot project with partners to adopt the Ponseti method.

This was in partnership with the Association of surgeons of Uganda, the Uganda nurses and midwives council, the Medical School at Makerere University and Mbarara University among others.

Medical students and nurses were taught how administer treatment in children born with clubfoot and awareness created in communities across the country. This has helped in managing clubfoot.

However the current Ministry of health statistics state that the incidence of clubfoot in children shows that of every 1000 children born 1 will be born with club foot.

Most affected are the boy child and the ratio is 2 girls to 3 boys. A few cases come with abnormalities of spinal Bifida where the spinal cord and nerves are usually fine, but there might be a small gap in the spine.

How to correct club foot and maintenance

Mr Kitemagwa contends that clubfoot happens because the tendons  which are bands of tissue that connect muscles to bones and muscles in and around the foot are shorter than they should be.

He says usually Doctors don’t know what causes it and there’s no way to ensure that the baby won’t be born with it. But babies with a parent or sibling who had clubfoot are twice as likely to get it.

Others are lifestyle choices where the mother is a chain smoker or a drug addict and is practicing these things while pregnant

Lack of amino acid fluid, calcium in the mother is a challenge the reason mothers are encouraged to attend antenatal so that they are given Magnesium tablets to boost immunity of the baby.

The widely accepted method is the Ponsetic treatment method which involves manipulation of the tissue of the baby and casting.

The Ponseti method was developed by Dr Ponseti, an Orthopaedic Surgeon based at the University of Iowa in 1963 following extensive anatomical study of the foot

It has been shown to be safer and more efficient than surgery for the treatment of clubfoot.

This technique according to Katemagwa uses a very specific series of manipulations and castings to correct the foot deformity and complete tenotomy of the Achilles’ tendon in most cases to eliminate deformity followed by a further three weeks in a cast. 

The patient must then wear a foot abduction orthosis, a set of boots set attached on an immovable bar fulltime for three months. Thereafter at night at least until the age of four.

If used correctly, results of the Ponseti Method can achieve full correction of the clubfoot deformity in up to 98% of the cases.

There is a network of clinics support in all referral hospitals in the country which was started three years ago through a memorandum of understanding with the Ministry of health and Mirafit hospital in the US.

This initiative is to give free treatment for children born with clubfoot although Mulago hospital has been treating patients with clubfoot over a long period of time.

In the case of Mulago hospital Mr Katemagwa notes that about 200 children born with clubfoot are registered every year but overall in all government hospitals about 2,067 are registered per year.

On average the number of correction done in all the government hospitals is about 720 per year meaning over90% have been corrected.

The casting is done using local Anesthesia and no tablet is given to the children.

Clubfoot the case of private hospital

Dr Joseph Isanga an obstetrician and Gynecologist at CAS hospital in Kampala notes that due to a lot of sensitization for mothers to avoid things such as drug use and tobacco smoking during pregnancy, clubfoot is becoming relatively minimized.

Since he is operating in a private hospital where few mothers come to give birth due to cost implications, he has so far seen 5 cases of babies being born with clubfoot for the last five years.

According to Dr Isanga, some cases are complicated and it can take between 6 months to 1 years to correct. Usually if parents cannot manage the charges in private hospitals they are referred to government hospital where the services are free.

To him it is important for mothers to attend antenatal care because it is at this stage that the baby is identified with clubfoot and the mother is counselled and told in advance.

It is at five months pregnancy when Gynecologists start screening mothers to detect any deformity of the baby.

He identified another cause of clubfoot to be lack of water in mothers to allow the baby move freely while in the womb. In such cases mothers are advised to consume foods that contain amino acid and calcium in addition of taking tablets which contain iron, folic acid and zinc. This will allow good born formation.

Challenge

Mr Katemagwa notes that usually mothers who come to the clinic come back for consequent visits with a few cases dropping out along the way due to transport challenges especially those who come from far.

Others drop out due to cultural reason because some think it is witchcraft or curse from God. Such people need serious counseling and sensitization.

For parents who delay to take their babies early enough, correction may be a challenge because of the expenses. It is important for mothers to start treatment at birth and it is important to send patients in hospitals with large number of patients to encourage others.

What happens if not treated?

The experts say if the child is not treated he or she may develop Arthritis, the unusual appearance of the foot may make your child's body image a concern during the teen years.

The twist of the ankle may not allow your child to walk on the sole of the foot. To compensate, he or she may walk on the ball of the foot, the outside of the foot or even the top of the foot in severe cases.

Walking adjustments may prevent natural growth of the calf muscles, cause large sores or calluses on the foot, and result in an awkward gait.