York Springs, PA, October 9, 2024 – A recently released, peer-reviewed working paper from the Kellogg Institute for International Studies at the University of Notre Dame highlights the essential impact that early clubfoot intervention has on the multiple dimensions of human flourishing (physical mobility, mental health, social inclusion, education, and religious faith). It is the first quasi-experimental study on clubfoot intervention and the first that takes a holistic look at the impact of various life outcomes of a child born with clubfoot.
Clubfoot is a common birth condition that twists the feet inward and downward and impacts nearly 200,000 children yearly. Clubfoot cannot be prevented, but medical professionals can treat it using a series of weekly casts followed by braces to maintain the correct alignment, known as the Ponseti method.
Early Treatment Essential
After studying Hope Walks’ clubfoot program in Ethiopia, the authors found that untreated clubfoot results in a significant decline in human flourishing, and the use of the Ponseti method realizes “large and significant impacts” across all the identified facets of human flourishing. They conclude “early treatment (≤ six months) to be essential for significant impact on later-life outcomes” and compare favorably to other surgical interventions such as cleft palate and cataract repair.
The authors note that early clubfoot intervention on human flourishing is “extremely high relative to the impacts of most educational and health interventions” in low- and middle-income countries, suggesting it would be beneficial to “significantly” increase resources directed at early clubfoot treatment in these parts of the world. The effect of greater investment in early clubfoot intervention could also have far-reaching consequences because the authors estimate the negative impact of untreated clubfoot to be “approximately three times larger than those found from untreated cleft palate.”
“It is encouraging to see that an independent and rigorous academic study has concluded that our early clubfoot treatment makes a significant difference in the lives of the children and families we serve,” Hope Walks President Scott Reichenbach said. “It further confirms what we have always believed — investment in early clubfoot treatment radically transforms the physical mobility, emotional and relational aspects of these children.”
The study interviewed mothers of 564 Ethiopian children born with clubfoot and their nearest-age sibling to compare human flourishing. In the sample used, 40% of the children born with clubfoot were untreated and the remaining 60% were treated. Of the treated children, 63% received early treatment (before six months of age).
Stark Differences Noticed
The study found stark reductions in physical mobility, mental health, social inclusion, education and faith of their religious community for children whose clubfoot went untreated. Likewise, early clubfoot treatment was shown to restore outcomes in these five areas closer to those of a child’s nearest-age sibling.
Impairments in physical mobility are not surprising for a condition that twists the feet out of proper alignment; however, it is worth noting that this physical condition also hurts both mental health and social inclusion.
Parents of children with untreated clubfoot reported lower levels of mental health in their children, specifically in areas of self-esteem, aspirations, anxiety and depression. At the same time, early intervention restored about 68% of the decline in mental health caused by clubfoot at birth.
Similarly, children with untreated clubfoot experienced a reduction in social inclusion, the number of friends, frequency of leaving home with friends, inclusion in social circles, and frequency of bullying. Early intervention improved these factors by about 60%.
Clubfoot’s existence also impacts education and religious faith, with positive results seen in children when medical professionals treat their clubfoot early. Overall, the study’s authors estimate that early treatment of clubfoot restores between 71-82% of human flourishing lost to untreated clubfoot.
Removing Barriers
Considering the positive impact of early intervention and the tragic declines related to untreated clubfoot in this study, it is essential to ask why such a large portion of children remain untreated. This study found mothers most often cited the following six reasons: lack of knowledge about the availability of treatment (76%), living too far from available clinics (71%), lack of time because of other obligations (67%), inability to afford costs associated with treatment (65%), lack of knowledge that clubfoot is treatable (64%), and lack of knowledge about the severity of the condition (57%).
These barriers suggest a primarily informational challenge, and if society addresses these hurdles, the volume of this “substantively life-changing intervention might be significantly increased.”
Hope Walks partners with more than 190 clinics in 14 Latin American and African countries, pairing quality clubfoot treatment with compassionate care from counselors (parent advisors), empowering local healthcare workers, and educating parents and caregivers. Hope Walks is a 501 (c) (3) public charity with a Four-Star Charity Navigator rating, Guidestar Platinum Seal of Transparency, Certified Transparent by Excellence in Giving, and accredited by the Evangelical Council for Financial Accountability.
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Study’s authors: Bruce Wydick, is a professor of economics and international studies at the University of San Francisco. He is a Distinguished Research Affiliate of the Kellogg Institute for International Studies at the University of Notre Dame. Patrizio Piraino is director of the Ford Program in Human Development Studies and Solidarity at the Kellogg Institute and professor of education, labor, and development at the Keough School of Global Affairs at the University of Notre Dame. Gianna Camacho is a recent graduate of the Masters of Science program at the University of San Francisco, where she also holds a Bachelor of Arts in International Studies.