Andrew Hogg on clubfoot in Africa: the video

Andrew Hogg While working in the orthopaedic department at Ngwelezana I spent a fair amount of time doing the clubfoot clinics. For those unfamiliar with clubfoot treatment, most cases can be corrected very successfully without needing any major foot surgery.

The treatment process was devised by an extraordinary Spanish American gentleman, Professor Ignatio Ponsetti , who struggled for many years to gain acceptance for his technique, which is now the preferred method for clubfoot treatment in most orthopaedic centres.

The basic treatment principles are not all that difficult to learn, but there are certain crucial factors that must be adhered to for the treatment to be successful. Once the doctor does his bit (applying the corrective plasters and performing the achilles tenotony), the baton of responsibility is handed over to the parents.

For the next three to four years the child has to wear special corrective boots to prevent recurrence of the clubfoot. The main reason for recurrence is non-compliance with the boot wearing.

At this point communication is critical. I spent many a clinic repeating the same instructions over and over again to my Zulu nurse (I only speak a bit of pidgin Zulu) for them to be translated to the parent – “you must set the boots at the correct angle,” “the affected foot has to be at 70 degrees, the normal one at 40 degrees,” “the foot needs to sit at the bottom of the boot,” “they must wear the boots at night time and nap time…” – I felt like a parrot.

The parents were mostly very keen to make sure they were doing things properly. I did have a bit of a chuckle when one child was presented to me by a very enthusiastic mum with its feet pointing backwards – something was lost in translation there, I think!

Although I very much enjoyed treating children with club foot, educating the parents and supervising their application of the boots was a very time consuming and repetitive process. I felt that we could do better and so I decided to make an educational video for the parents.

With children from our clinics, I made a step by step account of the treatment process, detailing all the necessary points for a successful outcome while also emphasising the importance of compliance. I bribed my boss’s secretary with some chocolates to do the Zulu voiceover and put some subtitles in English for our occasional white patients.

Once parents were able to watch the DVD my life became considerably easier in clinics. I knew that they had some background education about clubfoot and that they would have an idea about what to expect during the treatment process. I felt that if parents could see the end result in other normal children – as demonstrated in the DVD, they would be more likely to be compliant with the treatment.

Clubfoot is a very treatable problem, but if it is not corrected the consequences are devastating for the owner of the foot in question. Parental education is very important component for successful treatment, and I hope that this DVD has gone some way to help make the process a little bit easier.

Andrew Hogg is a SHO in orthopaedics at Guy’s Hospital, London. From October 2006 to June 2008 he worked at Ngwelezana Hospital, a South African government hospital just east of Durban in KwaZulu-Natal.

Patient consent obtained.