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A training course on Principles of Management for Delayed Presenting Clubfoot (DPC) took place 11-12th December 2023 at CURE Children’s Hospital of Ethiopia, Addis Ababa.

A patient receives treatment during the clubfoot training course © CURE International/Ammi Kifle
Assessing the severity of clubfoot in an older child

The training course was the beginning of a roll-out of training materials for treating clubfoot in older children, that were developed through an NDORMS project 2020-2022 led by Prof Chris Lavy and Grace Drury, funded by Tropical Health Education Trust – Africa Mother and Child Grant programme. The course focuses on management of walking age children with delayed presenting clubfoot who have received no prior treatment for their clubfoot. 

The course in Addis Ababa was organised by Global Clubfoot Initiative, and led by Dr Tim Nunn and the CURE Ethiopia team, with support from international trainers who were involved in creating the DPC training materials.  The trainers were: Dr Tim Nunn, Dr Wubshet, Dr Netsanet, Dr Birhanu, Dr Tracey Smythe, Mr Steve Mannion, Ashenafi Girma, Dr Laurence Wicks and Dr Alaric Aroojis. The course was attended by 7 participants from Ethiopia and 9 participants from Rwanda, DRC, Burkina Faso and Kenya, including orthopaedic surgeons, physiotherapist and nurses.

The course content included correction of the clubfoot deformity, assessment and treatment planning, applying casts, surgical correction, rehabilitation, team communication and planning family centred care. The course made space for participants’ own case studies, plenty of time for participants to reflect on their own practice and experience, and hands-on practical sessions with skeleton models.  The highlight of the training was the 12 children who attended, all of whom presented with delayed presenting clubfoot and ranged in age from 4 – 12.  None of these children had previously received treatment for their condition.  These patients started their treatment during the training and will remain under the care of CURE Ethiopia hospital for the duration of their treatment, which is likely to involve 2-3 months of casting, surgical intervention as appropriate, and rehabilitation.

Participants on the Principles of Management for Delayed Presenting Clubfoot (DPC) course in Addis Ababa© CURE International/Ammi KifleParticipants on the Principles of Management for Delayed Presenting Clubfoot (DPC) course in Addis Ababa

Participant feedback

‘Many thanks to all of you for this learning opportunity.  It’s been very rewarding.  We’re going to apply our new knowledge and train the rest of the team.’

‘We thank GCI, its partners, the faculty for the nice organisation and the practicality of the DPC course with challenging approaches.  Hope to develop the learnt skills through the mentorship of our teachers, staying connected.’

‘It was a very encouraging event, providing solutions for children with clubfoot 2-10 years, who have been very challenging to treat.  Thank you!’

‘I would like to thank the organisers and the faculty of this training, we learnt a lot of important points.  We promise to put into practice what we learned for the benefit of our children.’

Overall, the trainers felt that the course had been excellent, well received and had run smoothly.  They felt that the surgical and rehabilitation teaching resources were of high quality, there was plenty of time for networking with each other and the participants, and time for small group discussions and sharing of clinical cases. They observed high levels of engagement and interaction from participants, good questions and discussion. 

Prof Chris Lavy said: We are delighted to help expand treatment provision for older children with clubfoot, as untreated clubfoot can lead to pain, disability and exclusion. Clubfoot treatment is often life-changing for these children and their families.’

The course was funded by a generous anonymous donation to Global Clubfoot Initiative, which will fund 3 further regional DPC courses in Africa during 2024, including a training of trainers course.