The hidden burden behind Kenya's 2,000 clubfoot births

Doctors put corrective casting on a child with clubfoot condition at APDK Dissability Centre in Nairobi. [Juliet Omelo, Standard]

Nearly 2,000 children are born with clubfoot in Kenya every year, turning what is a treatable childhood condition into a long-term challenge for thousands of families who must navigate repeated hospital visits, treatment costs and the risk of the deformity returning.

For four-month-old baby girl whose mother, Beatrice Mweni Chalo, began treatment when she was just two weeks old, the journey has already involved months of plaster casts at Mama Lucy Kibaki Hospital.

Every Tuesday, Chalo returns to the hospital as doctors gradually correct the tiny foot that was turned inward at birth.

“The baby's leg was bad. Now the leg is straight,” she said.

The visible change has brought relief, but treatment is not yet over. Chalo still has to make the weekly trips, find money for transport and seek time away from work. Once the foot is fully corrected, her daughter will need to wear a brace to help prevent it from turning inward again.

Chalo said that the journey has not been without challenges and stigma.For weeks on end,she was forced to hide her babies feet from the neighbours who she noted would have otherwise not have understood what was happening.

"Not many people know about this condition and what it takes to correct it. In fact, I personally had not heard of it until my baby was diagnosed with the condition," she said.

Her experience reflects a wider challenge in the management of clubfoot in Kenya. Although the condition can be corrected, ensuring that children receive early treatment and remain in care until the process is complete can be difficult, particularly for families facing financial and social pressures.

Clubfoot is a congenital condition, meaning it is present at birth, in which one or both feet are turned inward and downward. The heel may be pulled upwards while the foot curves towards the other leg, giving the foot a twisted appearance.

The condition develops while the baby is still in the womb. It is not caused by something a mother ate, failed to eat or did during pregnancy. In many cases, doctors cannot identify a specific cause, while some children develop clubfoot alongside other conditions affecting the nervous system or other parts of the body.

For parents, however, medical explanations do little to soften the shock of seeing the condition for the first time. A newborn expected to arrive healthy may instead have a foot that appears severely twisted, leaving parents worried about whether the child will ever walk normally.

The condition is not covered under the Social Health Authority (SHA).Health officials have however been considering how clubfoot care can be incorporated more comprehensively into the SHA package, a move that could help reduce the financial burden on families

Dr Paul Man’goli, an orthopaedic surgeon and medical director of Clubfoot Care for Kenya, said early identification and treatment are important because the foot can be gradually corrected without the need for major invasive surgery in most cases.

Mang’oli explained that the main treatment is the Ponseti method, which involves gently manipulating the foot and holding the correction with a series of plaster casts. The casts are changed regularly as the foot is gradually moved into the correct position, with the process generally taking several weeks depending on the severity of the condition and the child's response.

According to the doctor, some children require an additional minor procedure called an Achilles tenotomy, which releases a tight tendon at the back of the ankle and allows the foot to move into the correct position. Once the correction has been achieved, the child wears a brace to maintain the position.

It is this stage that can become difficult for families because the foot may already look normal and the child may have begun walking. Parents can understandably feel that the problem has been solved, even though the brace remains an important part of preventing relapse.

“Once the child is walking and the feet are okay, they tend not to understand and drop out,” Mang’oli said.

When treatment is abandoned, the foot can gradually turn inward again, undoing months of correction and forcing the child and family to begin another cycle of care. For parents who have already struggled to attend appointments, the prospect of returning to treatment can be especially difficult.

"Untreated clubfoot can have consequences that extend into childhood and adulthood. Children may experience pain, difficulty walking, pressure sores and problems finding ordinary shoes that fit. The condition can also restrict participation in school, games and other activities that are part of normal childhood," he added.

The physical difference can carry a social burden as well. In some communities, disability is still associated with curses, wrongdoing or bad omens. Such beliefs can cause parents to hide children or delay seeking medical attention, allowing a condition that could have been treated early to become more difficult to manage.

Dr Andrew Toro, director of curative and nursing services at the State Department for Medical Services, said parents need accurate information about clubfoot and should seek treatment instead of hiding children because of stigma.

But knowledge alone does not remove the practical barriers. A parent may understand that the condition is treatable and still struggle to reach a hospital repeatedly, pay for transport or take time away from work.

Mangoli said the Ponseti method is cheaper than corrective surgery, although families still face costs associated with materials such as plaster of Paris and under wrap. Those expenses can be significant for households already struggling to meet daily needs.

“Most of the parents with children in clubfoot, most of them come from a humble background,” he said.

The challenge therefore lies not simply in whether Kenya has a treatment for clubfoot, but in whether children can consistently access it. A successful correction depends on a chain of care that begins with early detection and continues through casting, any necessary procedure and prolonged use of the brace.

For children without parents or a stable family environment, maintaining that chain can depend on social workers and institutions.

Maureen Nyaga, a social worker at a Nairobi children's centre, works with children from birth to six years old, including abandoned children, those rescued from difficult circumstances, missing children who have been found and children affected by trafficking.

One child under the centre's care was found abandoned in Machakos and rescued by a Good Samaritan. The child was taken to a hospital in Machakos before being transferred to Kenyatta National Hospital, where doctors identified several medical conditions, including clubfoot, a heart condition and Down syndrome.

With no parent to take responsibility for appointments, the child's care has become part of the work of the centre. Social workers have to keep track of hospital visits and ensure the child's different medical needs are followed up rather than allowing one condition to overshadow another.

Baby Moses,2 months old, remains under the centre's care and has further appointments, including an echocardiogram scheduled for October 7. The case illustrates how medical treatment can depend on a network of caregivers when a child has no family able to provide that continuity.

Across Kenya, organisations working on clubfoot are trying to expand that network. Clubfoot Care for Kenya, together with the Global Clubfoot Initiative and Hope Walks, has supported treatment and training in parts of Nairobi, the Coast, Western and Central Kenya. Northern Kenya remains among the areas where access to specialised services is more limited.

Training health workers is one way of extending treatment beyond specialist facilities. A five-day training-of-trainers programme brought together about 50 participants from Kenya and countries including Pakistan, Cambodia, Yemen, Somalia, Zambia, Zimbabwe and Burkina Faso.

The programme is intended to create a chain of knowledge, with trained health workers returning to their facilities and counties to train colleagues and expand the number of people able to identify and manage clubfoot.

The government is also considering changes that could affect access. Toro said the Ministry of Health is developing policy guidelines and protocols for clubfoot care and considering its inclusion in the Social Health Authority benefit package.

For families like Chalo's, such changes could matter most in the small, repeated decisions that determine whether treatment continues. A hospital appointment means transport has to be found, work arrangements made and household expenses stretched a little further.

Yet Chalo has one advantage that many parents may not have had when they first saw their child's foot: she can now see the treatment working.

Her daughter's foot, once visibly turned inward, is becoming straighter after months of casting. That change offers a glimpse of what early treatment can achieve, but it also underscores why correction cannot end when the foot first looks normal.

The brace that follows will become another part of the child's routine, helping keep the foot in position as she grows.

For Chalo, the process is measured not in a single hospital visit but in the gradual transformation of a foot and, eventually, in the possibility of her daughter walking without the condition defining her childhood.

Nearly 2,000 Kenyan children enter the world with clubfoot each year. For them, the medical path to correction may already be known. The challenge is making sure that the path remains within reach until the treatment is complete