Local NPO Spearheads Clubfoot Treatment Across South Africa and Beyond

Launched in 2005, STEPS is the only non-profit organisation in South Africa that is focused on the treatment of clubfoot across the country (and further). Founded by Karen Mara Moss, whose own son was born with clubfoot, its goal has always been to introduce and promote the non-invasive Ponseti method[1] of clubfoot treatment and to support families going through treatment.

“There is a high incidence of clubfoot in Africa and developing countries, all of whom have restricted resources,” says Moss. “In fact, it is estimated that 80% of children born with clubfoot live in developing countries.”

A common birth defect, clubfoot results in one or both feet (unilateral or bilateral) twisted inward and pointed downward. The foot is rigid and cannot be pushed back into the correct position. Most children born with clubfoot are not missing any bones, muscles, or connective tissue. It is also a congenital condition, meaning that when it occurs it is always present at birth.

“It often bears a stigma, and some patients are not brought for treatment. But clubfoot is a treatable condition with early intervention by trained health professionals,” stresses Moss!

Dedicated to the treatment of clubfoot and the support of families affected by it, 2013 saw the launch of the STEPS partner clinic programme, originally constituting six clinics across Gauteng, the Western Cape and Free State. Since then, the number of partner clinics has grown exponentially, currently sitting on a total of 38 clinics across all nine provinces with plans underway for another two come January 2023.

The success has been staggering. Between 2013 and 2022, a total of 8,305 new patients have been enrolled at partner clinics. Further, 17000+ children have been able to access the Ponseti method of treatment since the introduction of the method via STEPS in 2005.

On the back of Moss’ commitment and dedication over many years, South Africa is now recognised as a country with a sustainable clubfoot programme model that can be replicated in other resource-restricted countries. This has evoked extensive international interest, leading to the first ever global Clubfoot Africa Conference taking place in Cape Town from 21 to 23 November this year. Entitled ‘Moulding the Future’, this event will not only provide a platform for global experts and colleagues to come together to discuss treatment options but, as essentially, it will provide a platform for all stakeholders, including patients’ families, to receive cutting-edge information.

Says Dr Prihoda,Clinical and Scientific Affairs Manager of MD Orthopaedics, the platinum sponsor for this event, “MD Orthopaedics is honored to be part of this inaugural Clubfoot Africa Conference in Cape Town. Karen Moss and the entire STEPS South Africa team have done an exceptional job organising the event and bringing key thought leaders from around the world together to discuss ways to eliminate clubfoot disability in Africa. The growing movement to eliminate clubfoot disability in Africa relies heavily on providers but also requires technological support. The strong partnership between the South African Paediatric Orthopaedic Society (SAPOS), its current president Dr. Pieter Maré, and STEPS South Africa has done much to advance clubfoot treatment in the sub-Saharan region and eliminate barriers to treatment on the African continent, and there are other agencies working to achieve the same goal in other low to middle income countries.”

“In order to have successful clubfoot correction programmes, bracing banks need to be set up with affordable, quality clubfoot braces for the children,” says Todd Becker, Managing Director of Clubfoot Solutions, a conference gold sponsor. “For some African countries access to quality bracing is a very large issue. The issue is long term sustainability in these bracing programs since the majority of Ministries of Health do not provide funding for clubfoot bracing.  In order to have successful clubfoot correction programmes bracing banks need to be set up with affordable, quality clubfoot braces for the children.”

Ramesh Tiloke of Essity, a leading global hygiene and health company and another conference gold sponsor, concurs, “The choice of good quality casting material such as Gypsona Plaster of Paris is of utmost importance for the treatment and quick correction of clubfoot, together with the necessary training to ensure the correct use of these materials and treatment protocols. Advanced training in the Ponseti method is an eye opener in the treatment of more complex cases.”

“Early detection, treatment and care is critical in order to prevent long term disability caused by untreated clubfoot,” continues Moss. “Approximately 54% of children in South Africa under the age of five are deprived in the area of health.” (Stats SA 2020 – Child Poverty in South Africa: A Multiple Overlapping Deprivation Analysis). “We need to extend our services and treatment to reach those who are unable to access it. And we need to look at practical ways of doing so with the utilisation of relevant and available resources, such as physiotherapists, and specialist nurses in the execution of clubfoot treatment.”

For more information, please visit Clubfoot Africa Conference or contact STEPS.

[1] A non-invasive treatment, the Ponseti method requires a 4–8-week correction phase where the foot is gradually positioned into place with a series of manipulations and full-leg plaster casts, changed weekly. A minor procedure is than performed which can be done using local anaesthetic, after which the maintenance phase begins.