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Towards Effective Ponseti Clubfoot Care: The Uganda Sustainable Clubfoot Care Project

  • Symposium: Clubfoot: Etiology and Treatment
  • Published:
Clinical Orthopaedics and Related Research


Neglected clubfoot is common, disabling, and contributes to poverty in developing nations. The Ponseti clubfoot treatment has high efficacy in correcting the clubfoot deformity in ideal conditions but is demanding on parents and on developing nations’ healthcare systems. Its effectiveness and the best method of care delivery remain unknown in this context. The 6-year Uganda Sustainable Clubfoot Care Project (USCCP) aims to build the Ugandan healthcare system’s capacity to treat children with the Ponseti method and assess its effectiveness. We describe the Project and its achievements to date (March 2008). The Ugandan Ministry of Health has approved the Ponseti method as the preferred treatment for congenital clubfoot in all its hospitals. USCCP has trained 798 healthcare professionals to identify and treat foot deformities at birth. Ponseti clubfoot care is now available in 21 hospitals; in 2006–2007, 872 children with clubfeet were seen. USCCP-designed teaching modules on clubfoot and the Ponseti method are in use at two medical and three paramedical schools. 1152 students in various health disciplines have benefited. USCCP surveys have (1) determined the incidence of clubfoot in Uganda as 1.2 per 1000 live births, (2) gained knowledge surrounding attitudes, beliefs, and practices about clubfoot across different regions, and (3) identified barriers to adherence to Ponseti treatment protocols. USCCP is now following a cohort of treated children to evaluate its effectiveness in the Ugandan context.

Level of Evidence: Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

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We thank the Canadian International Development Association, the Association of Universities and Colleges of Canada, Global HELP Organization, and the CBM International for their encouragement and support for the Uganda Sustainable Clubfoot Care Project. We also thank Dr Jacinto Amandua, Dr Deo Bitariho, Sue Cutts, Marieke Dreise, Veronica Dumba, Dr John Ekure, Dr Lawrence Ekware, Sam Jjumba, Sam Kayondo, Benon Kaziba, Dirissa Kitemagwa, Brad Locke, Theresa McElroy, Dr Geoffrey Madewo, Dr Didus Mugisa, Henry Musoke, Dr David Muzira, Stella Nema, Dr Isidor Ngayomela, Stella Nyange, Alfred Otim, Professor Nelson Sewankambo, Dr Stephen Ssebaggala, Dr Lynn Staheli, Michiel Steenbeek, Dr Gonzaga Waiswa, Dr Nathan Wanawa, and Dr Sam Zaramba for their valuable contributions to the Project. We thank the Rotary clubs of Burnaby and New Westminster Royal City, Rotary International and the Rotary Committee for International Development for their support for the introduction of Ponseti clubfoot treatment to Uganda.

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Corresponding author

Correspondence to Shafique Pirani FRCSC.

Additional information

This study was funded by support from the Canadian International Development Agency and the CBM International.

Each author certifies that where appropriate his or her institution has approved the human protocol for investigations and that all investigations were conducted in conformity with ethical principles of research and that informed consent for participation in the study was obtained.

All of the electronic supplementary materials have been reprinted with permission of their respective sources (Dr. George William Lutwama, “Prevalence of Physical Movement Disabilities Among Children in Rukungiri District, Uganda”; Dr. Joseph Theuri Macharia “The Idiopathic Clubfoot: Short-term Results of Treatment with the Ponseti Method at Mulago Hospital”; and Dr. Sam Zaramba, Director General of Health Services of the Uganda Ministry of Health, educational materials).

Electronic supplementary material

Below is the link to the electronic supplementary material.

Ministry of Health - Clubfoot Pamphlet (PDF 124 kb)

Ministry of Health - Clubfoot Clinic Appointment Card (PDF 109 kb)

Ministry of Health - Clubfoot Poster (PDF 6360 kb)

Konde Lule et al - Understanding Clubfoot in Uganda: A rapid ethnographic study (DOC 1365 kb)


Macharia - The Idiopathic Clubfoot: Short Term Results of Treatment with the Ponseti Method at Mulago Hospital (DOC 5447 kb)

Lutwama - Prevalence of Physical Movement Disabilities Among Children in Runkungiri District, Uganda (DOC 712 kb)

Ponseti Clubfoot Management: Teaching Manual for Healthcare Providers in Uganda (PDF 4143 kb)

Uganda Sustainable Clubfoot Care Project - Logical Framework Analysis (DOC 55 kb)

Uganda Sustainable Clubfoot Care Project - Narrative Summary (DOC 95 kb)

Radio Public Awareness Message 1 - English (WAV 8182 kb)

Radio Public Awareness Message 2 - Luganda (WAV 7622 kb)

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Pirani, S., Naddumba, E., Mathias, R. et al. Towards Effective Ponseti Clubfoot Care: The Uganda Sustainable Clubfoot Care Project. Clin Orthop Relat Res 467, 1154–1163 (2009).

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