Socio-epidemiologic characteristics and outcomes of children with Idiopathic Clubfoot at a rural district hospital in South Africa: A retrospective observational study of 5 years of consultations at the outpatient clubfoot clinic

Hlongwane, Lethabo

Socio-epidemiologic characteristics and outcomes of children with Idiopathic Clubfoot at a rural district hospital in South Africa: A retrospective observational study of 5 years of consultations at the outpatient clubfoot clinic

Thesis / Dissertation

2026

Publisher

University of Cape Town

Department

Division of General Surgery

Faculty

Faculty of Health Sciences

Abstract

Background Idiopathic clubfoot (ICF) is a common congenital deformity of the lower limbs that significantly affects the lives of children, especially in low- and middle-income countries (LMICs). The Ponseti method is the gold standard for ICF management. However, challenges related to compliance and follow-up often impede success in resource-constrained settings. Objectives This study aimed to evaluate the socio-epidemiological features and treatment outcomes of pediatric patients with ICF who received care at the clubfoot clinic of Tintswalo Hospital, located in rural South Africa, over a five-year period. Methods This retrospective observational study analyzed the records of children aged 1–60 months who were treated with the Ponseti method between 2016 and 2021. Demographic, treatment progress, and outcome data were collected using a standardized tool. Descriptive data was summarized and presented as frequencies and percentages.” Results In this study of 108 patients with clubfoot, the majority were male (64.2%), with most presenting between 1 and 24 months of age (83.3%). Most patients (91%) had idiopathic disease. A family history of clubfoot was reported in 14.5% of cases, and 55.2% of cases were bilateral. The Pirani scores showed that most patients (74.1% of the right foot and 73.1% of the left foot) achieved successful correction with a score of ≤1, although a small percentage (10.2% of the right foot and 6.5% of the left foot) had persistent deformities. A significant proportion (72.2%) of patients underwent tenotomy, a standard part of the Ponseti method, to achieve full dorsiflexion. Clinical attendance was poor, with only 29.4% of patients attending follow-up appointments 6 and 60.4% failing to return for further care. A significant dropout rate was observed, particularly during the maintenance phase (69.6%). Conclusion The Ponseti method is effective in correcting ICF during the corrective phase; however, difficulties in follow-up and compliance during the maintenance phase limit the assessment of its long-term success. Addressing barriers to ongoing care is crucial for achieving sustainable outcomes. Future studies should explore the reasons for non-compliance and investigate strategies to enhance adherence, particularly during the bracing phase.

Keywords

Ponseti method

Idiopathic clubfoot

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