Toddler with clubfoot learns to walk properly but many cannot access therapy

Thobeka Makopo-Nojoko was looking forward to celebrating the birth of her grandson at the height of the Covid-19 pandemic in 2020. But when the child was born with a  deformity, the  grandmother from Strand, outside Cape Town, confessed to being worried.

Apart from not knowing where to seek medical treatment for the now two-year-old Hlumelo-lwethu, she was worried about how people would react to him.

“I was shocked when I first saw that he had abnormal feet, turning inward. I did not know what it was, or how I was going to get help for him. The child was clearly different from other babies, and I was worried for his future and if he would be bullied.”

Hlumelo-Lwethu is one of more than 2,000 children in SA who are born with clubfoot — a common congenital deformity in which an infant's foot is turned inward, often so severely that the bottom of the foot faces sideways. If left untreated the condition can cause permanent disability.

This week clubfoot experts from 18 countries converged in Cape Town to discuss the condition and treatment options in the first-ever Clubfoot Africa Conference, hosted by Steps — a unique clubfoot care non-profit organisation that improves the lives of children born with clubfoot in southern and east Africa.

The Steps clubfoot model, which supports clubfoot clinics, trains health professionals on clubfoot care, assists with early referrals and distributes clubfoot braces, among its functions, won second prize in 2018 at the SAB Social Enterprise Disability Empowerment awards and was the audience's choice of winner.

Karen Moss, founder and director of Steps, said with clubfoot affecting one in every 500 babies born in southern and east Africa, it is has one of the highest incidences in the world.

“Clubfoot often bears a stigma, and some patients are not brought in for treatment. But clubfoot is a treatable condition with early intervention by trained health professionals.”

SA is recognised as a country that has a remarkable clubfoot clinic model “that can be replicated in other resource-restricted countries, hence the international interest in this conference”.

 Moss said while said there are many clubfoot clinics in SA, access to them remains a challenge, particularly for those who live in rural areas as they have to travel long distances and pay high transport costs.

While clubfoot was initially misunderstood, Moss said knowledge of the condition had improved.

“Years of advocacy have resulted in an increased understanding of clubfoot and greater access to the Ponseti method of treating clubfoot, which does not require invasive surgery and is more than 90% successful. This has made it possible for orthopaedic teams to treat children far easier as they don’t need theatre time for the majority of cases.”

The Ponseti method uses plaster casts to gradually manipulate the foot into a better position. 

“However, within communities there is still a lack of awareness that clubfoot is treatable, which often results in parents and caregivers bringing their children in when much older, which makes treatment more complicated and longer.”

Makopo-Nojoko said she experienced first-hand this lack of knowledge and stigma about clubfoot when her grandson was born.

“There was talk within the family, and in the community that the mother did not keep herself proper like the young woman that she should be.  People were saying that she was not faithful to one man and that is why she gave birth to a deformed child.

“In the community when a child is born different everyone tends to look at the mother and make unfounded judgments,” she said.

The family considers itself lucky to be living in a well-resourced province such as the Western Cape, which  meant that they had access to treatment almost immediately.

After going to a local clinic, Hlumelo-Lwethu was referred to Maitland Cottage Children’s Orthopaedic Hospital, a Steps partner clinic. 

“He started treatment for his clubfoot when he was two weeks and now he is two years old.  He is still visiting the clinic every three months and in the bracing phase. He is still in treatment, wearing boots every night.

“We were so happy as by the time he started walking, he walked just like a normal child.  There was a huge improvement from birth.”

Moss said while early treatment of clubfoot prevented disability “and allowed children to grow up with full mobility and live productive lives”, there are still gaps within the country’s public healthcare system, including unclear referral pathways and budget constraints.

“As with many other conditions and especially birth defects, there are gaps in budgeting and clubfoot is not generally a high priority.”

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