KARACHI: “Seeing my little daughter walking normally is like feeling she has gotten wings; now she can aim and fly high. I think that’s how other parents must be feeling today,” said visibly content Ashgar Ali, while sharing the story of her daughter’s recovery from club foot at a ceremony organised at the Indus Hospital (IH) on Saturday.

The event, ‘Club foot se jeet ka jashan’, is organised annually to celebrate the successful completion of the treatment programme for club foot, a birth defect in which an infant’s foot is turned inward often so severely that the bottom of the foot faces sideways or even upward.

This year, 160 children completed the four-year treatment.

Recalling the trauma and troubles the family went through when Aliya was born with a club foot three and a half years ago, Ali, a Baldia town resident, said: “We were extremely upset, more so because she’s a girl. Life with a deformity would have been very tough for her.”

The other reason of his concern, he explained, was his financial constraints. “I am employed at a textile factory, barely managing basic needs of my family of four at a rented place. Hence, opting for costly treatments was and is simply out of question for me.”

Looking for appropriate medical care at various health facilities for a week, the family finally reported at the Indus Hospital where Aliya received free-of-cost treatment.

Sharing experience of her two twin sons with club foot deformity, Shafaq Siraj, a young mother of four and resident of Orangi Town, said that doctors blamed her for birth defects and said it was due to “small space in her womb” which caused the deformity.

“Some relatives held lunar and solar eclipse responsible for birth defects. We, however, continued to seek better treatment and took them to another hospital where doctors used plaster to correct the deformity but they remained unsuccessful,” she said.

Ponseti method

The children were two months old when the family received appropriate treatment at the IH through Ponseti method, currently the most widely used technique in the world which uses gentle stretching and casting to gradually correct the deformity.

Explaining this technique and how it was initiated at the hospital under a programme, Dr Amin Chinoy, the executive director, physical and rehabilitation directorate, Indus Health Network (IHN), said that earlier only surgery was considered as the treatment option for club foot but recently experts had adopted the Ponseti method.

“It involves a series of plaster applications and popularised in 1990s in the world following studies showing it far effective than surgery,” he said, adding that it was seen that patients who underwent surgery developed pain after 15 to 20 years in the affected foot/feet.

The Ponseti method, he pointed out, was done in two phases. In the first phase, the baby would wore a series of casts over a few weeks or months, which gently moved the foot to the correct position. In the second phase, when the foot was in correct position, the baby was fitted with a brace, which made sure the affected foot/feet remained in correct position.

“There is significant improvement in most cases in six weeks. Some children, however, required tenotomy, a minor heel cord release procedure, before the last cast is put on,” he said.

In all cases, children would wear a brace once the foot was in correct position.

“Initially, they are required to wear it all the time for about three months and then only at night for four years,” Dr Chinoy said.

Pehla Qadam benefits 1,300 children

The method was launched under a programme ‘Pehla Qadam’, (first step) at the hospital in 2011 with the support of the Amer Haider Charitable Foundation and so far 1,300 children have benefited.

“During 2014-16, the IHN in collaboration with the University of Iowa, US, organised a capacity building programme under which more than 50 orthopaedic surgeons from across Pakistan were trained in the Ponseti method,” he said, adding that now a number of health facilities in Pakistan and in Karachi were offering this treatment, reducing patient burden on the IH.

Earlier during the programme, experts briefed the audience about the congenital deformity and said club foot had no known cause and it was one of the most common birth defects and affected one in every 1,000 live births.

The deformity, it was stated, could not be corrected without treatment and carried risk for complications if left untreated.

In 50 per cent cases, both feet were affected with males twice as likely to be born with it as compared to females. Once rehabilitated, children can live a normal, active life.

Experts estimate that 5,000 to 7,000 children are born with this deformity every year in Pakistan.

Published in Dawn, December 30th, 2018