Evidence map›Paper›PMID 40154971›Full record

Observational studyBMJ global health2025

Global clubfoot treatment in 2023: an overview of advances and outcomes.

Tracey Smythe, Rosalind M Owen, Adam Aspden, Jennifer Everhart, Endashawu Abera, Peace Amaraegbulam, Rosalyn Flores, Liza Valdez, Chris Lavy

Abstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in BMJ global health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it.

  1. Pooled it
  2. Review
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors.

Tracey SmytheInternational Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, UK.ORCID http://orcid.org/0000-0003-3408-7362
Rosalind M OwenPaediatric Orthopaedics, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK Rosalind.owen@globalclubfoot.org.ORCID http://orcid.org/0009-0002-4363-1067
Adam AspdenGlobal Clubfoot Initative, London, UK.ORCID http://orcid.org/0009-0004-0538-1700
Jennifer EverhartGlobal Clubfoot Initative, London, UK.
Endashawu AberaHope Walks Ethiopia, Addis Ababa, Ethiopia.
Peace AmaraegbulamOrthopaedic Surgery Department, Federal Medical Center, Umuahia, Nigeria.ORCID http://orcid.org/0000-0001-7082-9736
Rosalyn FloresDepartment of Orthopaedics, University of Santo Tomas Hospital, Manila, Philippines.ORCID http://orcid.org/0000-0001-6742-5036
Liza ValdezFundacion Solidaridad, General Pediatric Hospital Children of Acosta Nu, San Lorenzo, Paraguay.
Chris LavyNuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.ORCID http://orcid.org/0000-0001-8794-3789

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionApproximately 200 000 children are born each year with clubfoot, the majority of whom live in low-income and middle-income countries (LMICs). If untreated, clubfoot causes pain and reduced mobility, leading to activity limitations and disability. The Ponseti method is a highly effective and minimally invasive treatment. This observational study aims to quantify the countries providing clubfoot services and the children receiving treatment in 2023 and compares progress since data were first collected in 2005.

methodsIn January and February 2024, data on clubfoot treatment in 2023 were collected from 70 countries. Informants completed a survey about new cases enrolled, treatment outcomes and health system integration. Data were analysed using descriptive statistics, with adjustments made for duplicates, and included clinic locations, the number and ages of children starting treatment, types of support available and Ministry of Health involvement. We compared coverage trends over time and used a cartogram to visualise the extent of clubfoot programme coverage across countries.

resultsResponding countries accounted for 83% of all expected cases in LMICs. There was an increase in enrolment numbers, to 40 382, in 2023. Despite this progress, treatment coverage remained low at approximately 22% across respondent countries. While integration of clubfoot services into national healthcare systems varied widely, strong public-private partnerships in many countries suggest a foundation for sustainable, long-term treatment programmes. However, quality care remained a challenge, with only 67% of children receiving their first foot abduction brace, indicating gaps in ensuring comprehensive treatment necessary for successful clubfoot management. Lingering effects of COVID-19 restrictions include a higher percentage of cases enrolled after 1 year of age.

conclusionsA larger proportion of children in LMICs received Ponseti treatment in 2023 compared with 2005. However, more work is needed to expand national programmes, build sustainable, high-quality treatment capacity and ensure all children get the care they need to avoid lifelong disability.

Indexed as

ClubfootGlobal HealthChildDeveloping CountriesHumansInfantTreatment OutcomeChild healthGlobal HealthHealth policyHealth services researchTreatment

Identifiers

PMID40154971
PMCPMC11956389

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.