Clubfoot babies not punishment from God, orthopaedic surgeons tell parents

Angela Onwuzoo

To eliminate disability caused by clubfoot in Nigeria, parents of children born with the congenital deformity must present them early for treatment, orthopaedic surgeons have advised.

The bone specialists said parents should stop linking the birth of a child with clubfoot to a spiritual attack or punishment from God.

The surgeons said these myths and misconceptions which deny a lot of children access to treatment must be jettisoned if the social stigma attached to the condition must be checked.

Experts say untreated clubfoot results in a lifetime disability, causing pain, difficulty walking, stigmatisation, and limited access to education and economic opportunities.

According to the Cleveland Clinic, clubfoot is a congenital (present at birth) condition in which a baby’s foot or feet turn inward.

Approximately one in every 1,000 babies, the clinic states, will be born with clubfoot, which makes it one of the more common congenital foot deformities.

“Clubfoot happens because of an issue with your child’s tendons, the tissues that connect muscle to bone.

“The tendons in your baby’s leg and foot are shorter and tighter than they should be. That causes the foot to twist. About half of babies with clubfoot have an issue with both feet”, the clinic said.

No fewer than 10,000 children are born with clubfoot in Nigeria annually according to a non-governmental organisation, Nigeria Clubfoot Treatment Partners.

Currently, the cause of clubfoot is unknown (idiopathic). Still, experts say it may be due to a combination of genetics and the environment including a family history of clubfoot, smoking, alcohol intake, and intake of certain medications during pregnancy.

The orthopaedic surgeons who spoke exclusively with PUNCH Healthwise said clubfoot deformity is treatable, affirming that children who received treatment early had better health outcomes.

A Professor of Orthopaedic and Trauma Surgery, Mike Ogirima, said congenital clubfoot ( present at birth) also known as idiopathic clubfoot is a common congenital abnormality of the extremity and the most common type of clubfoot.

Prof. Mike Ogirima

Ogirima,  a past President of the Nigerian Medical Association, said the cause of idiopathic clubfoot is unknown.

He, however, said clubfoot, also known as talipes equinovarus, could be effectively treated through physical manipulations, stressing that surgery was no longer necessary since the manipulative treatment approach was adopted.

Ogirima, who is also the Provost, College of Health Sciences, Federal University Lokoja, Kogi State, said, “In the orthopaedic ward, it is one in 10,000 live births worldwide.  We have two types of clubfoot.

“There is the one we call the congenital type. It is the one that is quoted as being the most common congenital abnormality of the extremities of the foot that is inborn.

“It is also called idiopathic clubfoot because nobody knows the cause but a lot of factors have been associated with it. Those that are developed after birth are called secondary clubfoot or acquired clubfoot, which can be due to foot infection, trauma, and poliomyelitis.”

According to the orthopaedic surgeon, idiopathic clubfoot forms about 80 to 90 per cent of the clubfoot that bone specialists see, adding that it could also be hereditary.

He noted that the acquired type of clubfoot could also be corrected but must be based on the cause of the deformity such as accident and infection.

In 2020, the World Health Organisation published guidelines on standards for improving the quality of care for newborns in health facilities, recommending assessing and managing all newborns for congenital conditions.


Giving insight into the treatment of clubfoot and why children should be presented early to orthopaedic surgeons, the don said, “In the past, a lot of procedures were done, which were not necessary most of the time now,  that is a surgical operation.

“Treatment nowadays is more of a non-operative approach. It just involves physical manipulation. Surgical procedure is no longer necessary.

“Treatment is easier from day one of life and the most common that we offer now, which can offer up to 95 per cent correction of this idiopathic type of clubfoot is what we call the Ponseti.

“So we go by what is called the Ponseti treatment protocol, which involves serial manipulation of all the components of clubfoot.  After four to five weeks (sessions) of manipulations, you should be able to correct it, even the severe form.”

Ogirima expressed concern that despite increased awareness of clubfoot by orthopaedic surgeons who are now bringing the condition to the limelight, clubfoot was still associated with social stigma and myths in the country.

This, he said, often leads to late presentation of the child for treatment, stressing that this increases the cost of treatment because it might involve surgical procedures.

The orthopaedic surgeon said, “A lot of mysticism has been ascribed to clubfoot in Nigeria but we have come out to disprove that. There is a lot of social stigma associated with the condition.

“When a child is born with clubfoot, their parents will be feeling so guilty that maybe God has punished them for their past sins.

“The issue of witchcraft is also there and that is why up till now, some parents still have that social stigma of coming out with their children who have clubfoot.

“In the past, the traditional bone setters have been patronised in our environment. People go to ask if the deformities are a curse from the demigod or a curse from God as a punishment meted out by God to the family or parents of that child.”

According to him, these are false claims that have continued to hinder a lot of parents from taking their children with clubfoot for treatment.

“That is why annually now, many non-governmental organisations sponsor their treatment and go to hospitals and train people who will identify them at birth”, he added.

The professor went on to say that they still see adults coming with deformed feet, sometimes on both.

“Now, that one after initial manipulation may be subjected to surgery to get it corrected because of a late presentation. Late presentation is associated with the high cost of treatment.

“So, the earlier a child with clubfoot is presented to the orthopaedic surgeon, the better, the cheaper, and the less strenuous it is with treatment”, he added.

Ogirima advised pregnant women to avoid folic deficiency as well as alcohol intake, warning that alcohol is very dangerous in pregnancy and could lead to birth defects.

“It can affect the developing child. Then they should avoid radiation exposure and the use of non-prescribed drugs during the first trimester of pregnancy. Even Paracetamol should be avoided as much as possible because nobody knows which drug can cause a defect except the associations that we have seen”, he counselled.

Also, a Consultant Orthopaedic Surgeon and President of Nigeria Clubfoot Treatment Partners, Dr. Peace Amaraegbulam described Clubfoot as the most common musculoskeletal birth defect that causes the feet to turn inwards and upwards.

She said, “In Nigeria, over 10,000 children are born with this condition each year and without treatment, walking becomes extremely difficult and painful as children walk on the sides of their feet.

“This leads to discrimination, social stigmatisation, and loss of economic opportunities.”

Amaraegbulam, however, affirmed that the Ponseti treatment is an effective option for clubfoot.

She identified out-of-pocket payment for healthcare, poor access to healthcare facilities, inadequate number of healthcare professionals, and lack of foot-abduction braces as major factors hindering many Nigerian children with clubfoot from accessing care.



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