Prevalence and clinical presentation of congenital clubfoot amongst babies delivered in Mulago Hospital.

Abstract

Introduction: Congenital talipes equinovarus (CTEV) is the most common form of foot deformity with a birth prevalence of 1 per 1,000 births. While the etiology of CTEV is considered to be complex, the causes remain elusive. Genetic, maternal, and environmental factors have been suggested to play an etiologic role. There is no documented literature concerning the prevalence and clinical presentation of congenital clubfoot amongst babies delivered in Mulago Hospital. The etiology of idiopathic congenital talipes equinovarus is unknown, and there is no consensus as to the best treatment. Increasingly, ultrasound is being used to diagnose the condition prenatally, but the diagnosis remains clinical postnatally. Radiographs can help confirm the diagnosis and ascertain the severity of the condition. This disorder like other conditions is most likely to be detected when the clinician is aware that they do occur and is familiar with the way they might present and the frequency with which they are likely to occur in a particular group of individuals. An understanding of this common congenital anomaly in the orthopaedic assessment of young children will enable the health care provider to respond to parents' concerns with accurate information and counseling. As effort is made to complete corrective casting or surgical treatment prior to walking, so early diagnosis and orthopaedic referral are important. This study was undertaken to determine the prevalence at birth and clinical presentation of congenital talipes equinovarus amongst babies delivered in Mulago Hospital. Objective: The study was aimed at establishing the prevalence and clinical presentation of congenital clubfoot amongst babies delivered in Mulago Hospital so as to raise awareness amongst health workers and the public for early detection and treatment. Methodology: It was a descriptive cross-sectional study. Seven thousand six hundred and seventy-six (7676) babies delivered in the maternity wards were recruited consecutively and examined for presence of congenital clubfoot deformity. Using a pre-coded and pre-tested evaluation forms, data on demography was obtained and the babies were physically examined fully from head to toes. The collected data was then fed into a computer and analysed using the EPI-INFO version 6.4 and SPSS version 11.5 computer programmes. The results were summarized using frequency tables, bar graphs, pie charts and histograms. Results: Seven thousand six hundred seventy six (7676) newborn babies were examined for congenital talipes equinovarus during the study period. Nineteen (19) newborns (2.47 per 1000 livebirths) were found to have congenital talipes equinovarus. The male to female ratio was 1.4:1 and ratio of right to left feet involvement was 1.2:1. Thirty one percent was bilateral and 69% unilateral. Conclusion: The prevalence of CTEV at birth was high in this study. And majority of the cases was the idiopathic type. Recommendation: There is need to increase awareness amongst health professionals and in health teaching institutions that congenital clubfoot is a problem in our setting and therefore need for increase index of suspicion for early detection and treatment.