Internet chat rooms played an important role in the late 1990’s promoting the Ponseti method as the preferred initial treatment for congenital clubfoot. The social media boom has created multiple new methods for caregivers to seek support from a global community, using a variety of platforms. This study assesses the reach of information shared about congenital clubfoot on social media and analyzes topics most commonly discussed within these groups. Posts across Facebook, Instagram, Twitter, and TikTok were queried using the terms “clubfoot”, “talipes”, and “equinovarus” to identify pages primarily focused on congenital clubfoot. The top clubfoot-related hashtags and accounts were ranked and content themes of posts were analyzed across all platforms. There were 122 clubfoot focused Facebook groups for parent support. The 5 Facebook groups with highest engagement had the following most frequently posted topics: successful treatment stories, baby items compatible with clubfoot treatment, followed by questions about relapse, Ponseti casting, bracing, or Ponseti-qualified physicians. Twitter pages contained information about live webinars, educational resources for parents and providers, and the impact of the COVID-19 pandemic on clubfoot treatment. A search using “#clubfoot” yields over 58,000 cumulative posts on Instagram, and over 23.5 million total views on TikTok. Parents of clubfoot patients are connecting through digital social media platforms, relying on them for information on clubfoot, and utilizing them as a network of social support. Clubfoot physicians should be aware of this content on social media to promote education and discussion that addresses parent concerns, provides accurate information, and guides expectations.

Introduction: Ponseti casting is a well-studied technique for treating idiopathic clubfoot but there are limited studies describing the results in the Hong Kong population. We reviewed our experience of Ponseti casting to identify predictors of poor outcome. Materials & Methods: This is a retrospective study of patients treated at our centre since 2011. We included all children with idiopathic clubfeet. We excluded all cases of syndromal or neuromuscular clubfeet and cases with follow-up period of less than 2 years. Good outcome was defined as painless, plantigrade foot without need for further surgery other than split anterior tibial tendon transfer (SPLATT). Data analysis was done to identify risk factors for poor outcome using the Microsoft Excel and SPSS programmes. Results: There were 26 idiopathic clubfeet from 19 patients with an average follow up of 4.7 years (standard deviation (SD) 2.4). There were 5 non-Chinese cases. All cases were treated with serial casting and Achilles tenotomy followed by Denis Browne (DB) boot. Our SPLATT rate was 31% and the need for further surgery was 8%. Overall 92% cases reported good outcome. Chinese and non-Chinese cases were not significantly different in treatment outcome. The only significant factor that predicted poor outcome was poor full time DB boot compliance (p=0.04). Conclusion: Our study showed a disproportionately high percentage (19%) of non-Chinese cases, but the outcomes of Chinese and non-Chinese cases were similar. The one predictor for poor outcome was poor compliance to full time DB boot bracing.

Background: An Achilles tenotomy is routinely required to address the equinus deformity in Congenital talipes equinovarus (CTEV) patients as part of the Ponseti method of correction. Tenotomies can be performed under local anaesthetic (LA) or general anaesthetic (GA). The COVID-19 pandemic reduced theatre capacity and caused delays to CTEV patients’ treatment. The regional St George’s Hospital CTEV service has introduced a standard operating procedure that approved the tenotomies to be performed under LA in the clinic rather than theatre. Our study presents the results of a service improvement project looking into safety, feasibility and carers’ perspective.
Methods: The study was prospectively registered as a service improvement project (AUDI000712). All consecutive patients requiring tenotomies were treated under LA as part of the new protocol in the CTEV clinic rather than in theatre under a GA. Data was collected prospectively including demographics, Pirani score and a study-designed subjective anxiety and satisfaction questionnaire filled by the carers.
Results: 20 patients (29 tenotomies) were included in the study. The median age was nine weeks. All patients achieved post-operative dorsiflexion of greater than 15 degrees. All carers reported a positive experience and 95% felt less anxious about having the tenotomy done in the clinic rather than theatre. There were no readmissions or COVID related complications.
Conclusions: The new service offering clinic tenotomies was found to be safe, clinically successful and had excellent carer satisfaction. The service has improved the allocation of resources and due to its success, has continued beyond the pandemic.

Introduction: Clubfoot clinic volumes and new patient enrollments plummeted to 10% of pre-Covid norms in April/May of 2020. Within three months, volumes had risen to 60% and by January 2021 clinic volumes and new patient enrollments had rebounded to 96% of usual volumes. Despite hospital closures, lockdowns, lack of public transport, thousands of families persevered to ensure their children could access clubfoot treatment. What accounts for the extraordinary resilience of clubfoot care, even in vulnerable low- and middle-income countries? Methods and Results: We will report on the impact on enrollments and quality of care delivered that this global pandemic had on 300+ clinics across 29 countries, drawing on data from CAST, MiracleFeet’s extensive clubfoot patient treatment database as well as from phone interviews conducted with over 500 families. Findings include the importance parents place on accessing care, the quality of treatment that was delivered despite the challenges of Covid, as well as lessons learned in terms of supporting Ponseti providers and the families of children born with clubfoot. Discussion: Supporting capacity-building across the spectrum of care, through local partnerships and in collaboration with government hospitals and Ministries of Health, strengthened health systems in ways that held strong during Covid. Learnings gleaned from operating in these unprecedented times include the use of communication tools and tele-consults, and delivering blended trainings using online modules and Zoom.

Introduction: Restrictions on face-to-face healthcare services during the recent COVID-19 pandemic necessitated novel ways of providing follow-up care for clubfoot patients, to ensure maintenance of foot correction and bracing compliance. Live stream videoconferencing was used to connect clinicians in a tertiary centre to families at home, to assess function, range of movement, and foot position. Virtual clinics offer advantages for patients and health care providers, but must be clinically effective. This study aims to assess clinical confidence in telemedicine for this group. Method: A retrospective review of clinical notes of two matched cohorts of 100 children (0 to 13 years) seen face-to-face (F2F) and via telemedicine (TM) was performed. Identification of foot abduction bracing (FAB) compliance in the first 5 years, relapse of deformity and treatment provided were compared and analysed with Chi-squared tests. Results: In the F2F cohort (n=72 in FAB), compliance problems were identified and managed in 26%, compared with 23% in the TM cohort (n=70 in FAB) (p=0.63). In the F2F cohort, 20 (n=100) children presented with ≤plantigrade foot, and 9 with dynamic supination, compared with 16 (n=100) with ≤plantigrade foot, and 8 with dynamic supination in the TM cohort (p=0.71). 32% of each cohort required no treatment; all others received maintenance of FAB or individualised exercises, stretches or advice. No significant differences in rate of identification of compliance or relapse were seen between face-to-face and telemedicine. Conclusion: The use of telemedicine for routine follow-up of Ponseti treated clubfoot patients can be as effective as face-to-face assessment.

Purpose:The aim of this study was to explore parent’s experience of a diagnosis of clubfoot and impact of antenatal counselling. Methods: From Oct 2018 to Jan 2019, a retrospective observational cross-sectional survey recruited parents’ of children with clubfoot. A survey was distributed via social media platforms, including clubfoot parent forums. The questions focused on child/ parent demographics, diagnosis, counselling and initial clubfoot management. Results: 122 parents were recruited. The mean age of the children was 6-7 months (206.44 days, 95% CI 187.28, 225.6), with average age a start of treatment at 21 days (95% CI 17.9, 24.7). Diagnosis: 89 parents (73%) received an antenatal diagnosis of clubfoot. The majority of parents (94.1%) reported moderate to severe levels of anxiety at diagnosis. There was no significant difference in anxiety levels between those with an antenatal diagnosis versus a postnatal diagnosis. However, postnatal diagnosis resulted in a significant delay in starting Ponseti treatment, compared to antenatal diagnosis. Antenatal counselling: Of parents with an antenatal diagnosis, 43% received antenatal counselling, at a mean gestational age of 24 weeks (95% CI 22.4, 26). Anxiety levels were significantly lowered following antenatal counselling (p<0.0005). Additionally, counselling performed by a healthcare professional who would later be involved in the treatment of their child showed significant reduction in parent’s anxiety (p=0.008). Conclusion: Antenatal diagnosis with counselling by a healthcare professional who will later be involved with treatment, not only decreases anxiety, but allows efficient access to treatment pathways than those without an antenatal diagnosis.

Background: The Ponseti method is well-established for the treatment of clubfoot in younger babies; however its effectiveness in older children is still unclear. The aim of our study was to report our results of the Ponseti method in the management of clubfoot in children of walking age Methods : 56 children (81 clubfeet) with a mean age of 3.16 + 2.35 years (1 - 10 years) were divided into two groups : Group I consisted of 12 patients (18 clubfeet) who presented with an untreated clubfoot while Group II consisted of 44 patients (63 clubfeet) who presented with a recurrent clubfoot. All children underwent the standard manipulation & casting technique described by Ponseti, including a percutaneous tenotomy of the Tendo Achilles. Results: All feet corrected with a mean of 7.36 casts (3 – 17) in Group I and 4.49 casts (1 – 12) in Group II. All children in Group I and 70.45% in Group II underwent a percutaneous Tendo Achilles tenotomy. Nineteen patients (30.86%) underwent relapse at a mean follow-up of 2.84 + 1.25 years (1.2 – 5.4 years) which were treated by re-casting, bracing and tibialis anterior tendon transfer. Conclusion: The Ponseti method is effective even in walking age children up to the age of 10 years with a good success rate, although around one-third of the clubfeet relapsed and needed further treatment. Despite a high relapse rate, a supple, plantigrade and pain-free foot is achievable without the need for extensive soft-tissue surgeries or bony procedures.

The Disability Adjusted Life-Year, or DALY, is a metric that has been widely used in the field of public health to estimate regional and global disease burden. Several recent studies have shown the comparative cost-effectiveness of treating clubfoot, however, there is currently no separate DALY for untreated clubfoot. In the recently published GBD studies, clubfoot is included with “congenital musculoskeletal and limb anomalies.” The weighted score, or disability weight, used to calculate the YLD and DALY for this category is based on several multiple small studies reporting the quality of life of individuals with congenital limb deficiencies residing in high- income countries with strong social programs and universal healthcare services. The burden of disease representing of clubfoot is, therefore, likely underestimated, and unlikely to reflect the burden of the consequences of untreated clubfoot for individuals living in LMIC. Experts with GCI and lead clubfoot organizations have endorsed a disability weight that approximates the disability of untreated clubfoot to facilitate global advocacy for a WHO strategy for clubfoot. This presentation would introduce the problem, our calculation methodology, discussion, and implications.

For many countries like India, it is the responsibility of the government to assure health care for the population. But the vastness of the country and the population makes it an uphill task. This requires organizations outside the government to assume part of that responsibility. We analyse the Clubfoot clinic model at a Government hospital in Karnataka, India which is being run in collaboration with a Non-government Organisation [NGO]. Method: This study was based at a government hospital in Karnataka India, data between 2010 to 2020 was collected. The structure, functioning, roles assumed by the government & NGO, coverage and outcomes of the clinic was analysed. Results: The clubfoot clinic was started in 2010. The basic infrastructure, doctors, plaster of Paris is being provided by the government, whereas the NGO takes care of the documentation, provides braces and support staff for counselling and awareness. The clinic provides free treatment and has grown exponentially in the past 10 years, initially enrolling 18 patients but now has a total 1584 patients enrolled. The clinic caters to the surrounding 9 districts and also serves as a referral center. The clinic casts on an average 46 patients every week and has completed treatment in 425 patients with no relapse after 5 years. The relapse rate at our center was 20.5%, they were managed by various methods. Conclusion: The study indicates that government- NGO collaboration is an effective and sustainable way of improving access and providing quality clubfoot treatment in a vast country like India.

BACKGROUND: In 2020, providers of services for children born with clubfoot globally faced unprecedented challenges due to Covid19.
AIM: To understand the impact of Covid19 on clubfoot treatment and the mitigating factors shared amongst professional and NGO networks in lower and middle income countries (LMIC).
METHOD: This study used a mixed methods approach, to provide a wide breadth of information. Quantitative data on the impact on service delivery was gathered from a survey in October 2020 of all LMIC with >50 expected clubfoot cases/year. Qualitative data was gathered from meeting minutes with professional and NGO networks between March 2020 – January 2021, analysed thematically.
RESULTS: The survey response rate was 67% by country. Clubfoot services were impacted for an average of 15 weeks, with service disruption at 65%. Challenges due to Covid19 included: treatment delays and interruptions, problems with patient attendance, difficulties with providing treatment safely and disruption to wider clubfoot programme activities such as training. Through a facilitated collaborative network providers found and shared mitigating solutions to some challenges, such as treatment adaptation, optimising brace provision, creating and sharing guidance, use of telemedicine and blended learning approaches.
CONCLUSION: The impact of Covid on clubfoot treatment provision is likely to result in children experiencing sub-optimal treatment outcomes or missing out on treatment altogether. However, service providers have found ways to adapt and mitigate negative impacts. The qualitative data represents a relatively small, homogenous sample but is a rich source of information which may be generalisable to other settings.