Healthy Living

Surgery gives clubfoot children hope

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By Frederic Musisi

Posted  Monday, December 16   2013 at  02:00

In Summary

If detected early, a clubfoot can be corrected and a child can walk properly again. However, because most people do not know about the condition, they seek medical care when it is late.


Claudine was a proud mother of two. But that was until she had her third child. Her child had been diagnosed with a limb deformity—a clubfoot. Clubfoot is a congenital deformity where one or both feet are turned inwards at the ankle and can only be reversed by a small surgical procedure.

A person with clubfoot usually experiences pain since the feet get cracked as they walk on the back of the feet. Claudine’s first two children were born without disability so when the third, Shallom, was born in neighbouring Rwanda, there was panic and worry. At the time, Claudine’s husband had migrated to Uganda to find job she was left alone to deal with her son’s disability and what it meant for his future.
“I was scared and felt so sad when I saw my little boy because I had never seen anything like that,” she explains. Claudine and her husband were later introduced to the comprehensive rehabilitation services in Uganda (CoRSU), a hospital that treats such deformities.

At the hospital, they were told about a surgical solution to correct the deformity. This would involve serial casting or what is known as the ponseti method.
It involves a minor operation to correct the feet and later, the child is required to temporarily wear a small club foot shoes to position the limbs in the right direction.

Clubfoot unlike other limb deformities treated at the Entebbe-based hospital does not require amputation. But hundreds of children (and adults) are amputated every year because their condition is treated late.
Claudine is hopeful that after surgery and rehabilitation, her son will have a normal life again.
“I was so happy when I learnt that there was treatment for this condition and that it would give my son another chance,” she joyfully narrates

A health worker at the hospital said: “Shallom will have to wear the clubfoot shoes to help his feet grow in the right position. And this is possible before his condition is addressed while he is much younger. But when a child grows older it becomes complicated.”

Some of the major causes of amputating children’ limbs include congenital deformities that are incompatible with function, tumours or cancers and infections which are a threat to life.

Correctable condition
While many of the limb deformities can be corrected, most parents come to the hospital late.
CoRSU says most of the amputations carried out on children at the hospital are preventable, only if parents can seek immediate intervention. Dr Antonio Loro, a senior orthopaedic surgeon at CoRSU notes that most amputation cases in children are as a result of parental ignorance and negligence about bone limb defects.

He adds many patients confess on how they spend innumerable amounts of money and time seeking treatment and healing from traditionalists and by the time they seek medical treatment, it is already too late.

“Congenital deformity is the most common cause of amputation in children,” Dr Loro notes, adding that some children are born with weak limbs which necessitate replacement and in most cases amputation when all hope and effort has become futile.
Dr Loro explains several cases of cancer in children that go unnoticed and show up later in life may lead to amputation of the affected limb, largely to remove tumours or prevent any further spread to other parts of the body.

Artificial limbs and rehabilitation
According to Moses Kaweesa, an orthopaedic technologist, every amputated child has a right to a prosthetic limb although most parents are limited by money even when they are helpful.
He noted that, after the amputation process and eventual healing, measurements of the patient and missing body are taken to determine its manufacture, although one artificial limb may cost up to Shs2m, depending on the quality and type.
Kaweesa gives a classification of four types of limbs needed by amputated children, largely depending on which part of the body is missing.

These include; a transtibial limb that replaces a missing leg below the knee, a transfemoral limb that replaces a missing leg above the knee, a transraddial limb that replaces a missing arm below the elbow and a transhumeral limb that replaces a missing arm above the elbow.

He further notes that artificial limbs help to give hope to the amputees and also ease movement.
“Children learn easily to use these artificial limbs. Because they are always playing here and there, it usually takes them between four to eight weeks,” Kaweesa explains.

Similarly, Dr Loro adds once the amputation is carried out, healing can take between two to four months, and during this period, the patient is prepared for the prosthesis and rehabilitation. However being costly, some parents opt not to procure artificial limbs for their children and as such leave them with complete disability.