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The tech improving access to clubfoot treatment



Clubfoot describes a range of foot abnormalities usually present at birth in which the baby’s foot is twisted out of shape or position.

As many as 9.75 million people alive today were born with clubfoot and up to 8 million never received treatment.

Chesca Colloredo-Mansfeld is Co-Founder and Strategic Advisor of MiracleFeet.

The charity is on a mission to create universal access to treatment for this leading cause of physical disability worldwide.

We called up Chesca to find out more.

What are the main challenges of providing medical care to children with clubfoot in low and middle income countries (LMICs)?

The lack of doctors is a major challenge as the ratio of doctors to population is often very small.

Also, amongst the doctors who are present, there is a lack of specialisation, and/or a lack of specialised care.

There is also a lack of awareness about the condition which poses a huge challenge for patients and healthcare workers.

9.75 million people alive today were born with clubfoot and as many as 8 million never received treatment – a staggering statistic and indicative of the enormous need for integrated treatment.

There’s also still a lot of misinformation and stigma surrounding clubfoot, and many do not know that treatment is not only possible, but also relatively simple.

Ironically, these challenges are also the reason treating clubfoot globally is possible.

Treatment doesn’t require specialised care, expensive materials, or fancy operating theatres.

With proper Ponseti training, orthopaedic officers and casting technicians can treat clubfoot.

Also, the only supplies needed are plaster of Paris and braces – which MiracleFeet supplies – so treatment is available for very little or no cost to families.

How does technology help MiracleFeet streamline clubfoot medical care in low-income countries?

During the early years of MiracleFeet, when we only had a few clinics, we could visit them in person and monitor treatment quality to ensure we were meeting the high standards we set for ourselves.

But, as the organisation grew, it became obvious that we needed a more robust and streamlined data collection tool to support and track patient progress across our growing global network of clinics and providers.

Designing the tool was a long and involved process, but thanks to a fortuitous Google.org grant, we were able to work with Dimagi, a technology firm specialising in developing technologies specifically suited to low-resources settings, to develop our mobile data collection app, CAST.

The app helped us amplify our focus on treatment precision and program quality and transformed how we gather and use real-time data worldwide.

As the technology reflects patient treatment in real time, it’s easy to see and monitor the status of each child’s care: we can simply check on our phones. This has allowed us to scale quickly without sacrificing quality.

Chesca Colloredo-Mansfeld

We can use the data to identify trends and tailor treatment needs (for example, if one clinic has a high relapse rate, we can address that specifically).

If something is flagged in CAST, the centralised team can work with the local teams to find a solution.

The in-country providers know what will work best in their area, and this knowledge, along with the information shared on the platform, drives decision-making – a much more streamlined and customised way of working.

Not only does this help with internal monitoring and reporting, but also the data provides a fantastic way to demonstrate transparency with external stakeholders.

It’s important to show investors how we’re using our funding, and who we’re helping.

During the pandemic, this technology and data were especially useful, allowing work to continue without the need for the central team to visit the clinics in person, as all processes were fed through the app.

Because everything could be done online, the team didn’t skip a beat.

We were able to use CAST data to identify how long a child had been in a cast, allowing the caretakers to respond and advise without requiring the child or parent to come the clinics.

Technology has also helped us streamline care in LMICs by enhancing our provider training offerings.

Increasing the number and availability of trained providers is central to our model of expanding sustainable access to treatment.

To supplement the hands-on training providers receive, MiracleFeet developed a digital version of the standard clubfoot training curriculum called ACT Online.

This eLearning platform enhances training outcomes and serves as a critical reference for new and experienced providers.

Additionally, in partnership with the Pan American Health Organization (PAHO), we just completed development of a course to raise awareness of the prevalence, impact, and treatability of clubfoot.

Available in English and Spanish, the course is part of PAHO’s virtual campus for public health.

Looking at healthcare in low-income countries as a whole, is there more to be done to better provide medical care in these places and do you think technology can play a role in this and how?

There’s certainly more than can be done.

Telehealth easily connects patients with providers and is especially useful in areas where accessing care is difficult due to geographic and other barriers.

On the same note, telehealth can also help link providers to mentors.

As we expand treatment in primary healthcare facilities, this will create a network of training and support.

Integrating clubfoot identification, referral, and treatment into primary health facilities means treatment is more widely available and accessible.

Does MiracleFeet have any further updates to its technology which are planned to help better streamline the clubfoot care they provide?

We plan to expand some of the telemedicine programs that were initially utilised during COVID but which have the potential to be used in other ways, including helping reduce travel to clinics for follow-up appointments.

Additionally, some more customised and advanced technology such as a brace sensor could play a role in supporting treatment compliance and bracing adherence.

This is still in the preliminary stages of development, but we see a lot of potential for technology that can detect if a brace is being worn properly, and how often.

Similarly, we see potential for an incentive-based app that tracks and rewards proper adherence.

We are also investigating the feasibility of an addition to the CAST app that would allow midwives and frontline healthcare workers to identify children with clubfoot at birth so that MiracleFeet partners could pro-actively follow up with families with information about how and where to find treatment early.

For blue sky thinking, one day we may see drones being used to deliver the next size up shoes and braces as a child grows – who knows?!

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