Cookies on this website

We use cookies to ensure that we give you the best experience on our website. If you click 'Accept all cookies' we'll assume that you are happy to receive all cookies and you won't see this message again. If you click 'Reject all non-essential cookies' only necessary cookies providing core functionality such as security, network management, and accessibility will be enabled. Click 'Find out more' for information on how to change your cookie settings.

Development of training for treatment and surgical care for walking children with delayed presenting clubfoot in Ethiopia.

before and after pics of child with clubfoot© CURE International

Above: before and after treatment for delayed presenting clubfoot.

January 2024 update

September 2021 update 


Funder: Tropical Health Education Trust (THET) Africa Mother & Child Grants Programme, funded by Johnson & Johnson Foundation Scotland

Project duration:  21 months                 Project dates: 1 August 2020 – 31 March 2022 


  • UK Partner: Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford (NDORMS). Prof Chris Lavy (project director) and Grace Drury (project manager)
  • LMIC Partner: CURE Ethiopia Children’s Hospital.  Dr Tim Nunn (project director)


In addition we are delighted to work with:

  • Global Clubfoot Initiative, 
  • Black Lion Hospital, University Teaching Hospital, Addis Ababa
  • CBM (Christian Blind Mission)
  • Hope Walks
  • Colleagues from orthopaedic training institutions in Ethiopia including St Paul’s Hospital Millennium Medical College, University of Gondar Teaching Hospital and Bahir Dar University, Tebebe Ghio Specialised Teaching Hospital.  
  • CURE International UK
  • A wider project stakeholders group including MiracleFeet.

 Africa Grants Programme partner logos

 Background & need  

There are thousands of children who await clubfoot treatment in Ethiopia; including long waiting lists at CURE Ethiopia, the leading elective children’s orthopaedics centre in the country. CURE Ethiopia conducted a training needs analysis that identified potential partner institutions where there could be opportunity to scale up services providing clubfoot treatment to older children. Since an earlier project developing training materials for children 0-2years with clubfoot, we have received many requests from trainers in the sub-Saharan Africa region requesting more resources to treat older children with clubfoot who did not receive treatment as babies. We have been working with CURE Ethiopia on research studies developing the evidence base on management of older children with clubfoot.

Project Aim:

Increase the capacity of health workers (surgeons, physios, clinical officers) in surgical management of delayed presenting clubfoot in walking children, an underserved population. To do this, the project will develop and pilot a one-day training course and materials, train and mentor new trainers, and then roll-out the training course. The project aims to strengthen the workforce, improve surgical capacity, and improve both national and regional surgical training capacity for children with clubfoot and with clubfoot care for older children.


We have developed a 1-day surgical training course on management of delayed presenting clubfoot. This involved:

  • A survey of the community of practice 
  • Consultation with an expert panel
  • Gathering a multidisciplinary technical advisory group 
  • Creating technical teaching videos to cover surgical techniques and rehabilitation 
  • Applying lessons learned and teaching approach from Africa Clubfoot Training project
  • Piloting the course in Addis Ababa  
  • Translation of materials to Amharic
  • Mentoring of course participants and future trainers
  • Support for roll-out of training nationally
  • Making the course available to others in CURE and GCI network who wish to pilot in other settings.
  • Monitoring and evaluation of project activities, and sharing of results and lessons learned.


We have created the training course 'Principles of Management for Delayed Presenting Clubfoot (in walking age children 2-10 years)' to focus on management of children with delayed presenting clubfoot who have received no prior treatment. The course has been designed primarily for use in Ethiopia, with potential for piloting and roll-out in other settings in Africa and by other GCI partners where DCP is commonly seen.

The course includes core topics on:

The older child with delayed presenting clubfoot
Correction of the CAVE deformity
Assessment and treatment planning for DPC
Applying casts to older children
Surgical correction
Rehabilitation and exercises
Team communication and planning family centred care
When to stop and rethink

The course comprises interactive teaching presentations, practical workshops on assessment and casting of the clubfoot and a new series of teaching videos to support the course content. The videos cover:

Physical Examination
Assessment of the PAVER Score
Assessment of the Midfoot in Making Casting Decisions
Cavus Correction Cast
Adduction Correction Cast / Rotation around the Talar Head
Caudal Block
Timeout Section of the WHO Checklist (before Skin Incision)
Relevant Anatomy while Performing an Achilles Tenotomy
Percutanous Achilles Tenotomy
Hoke Achilles Tendon Lengthening
Cast Wedge Removal
Tibialis Anterior Tendon Transfer
Abductor Hallucis Recession & Lateral Column Shortening
Physio Class During Casting
Post Cast Exercises
Post Cast Walking Clip
Patient Experience

Sustainability & Dissemination after the project

We are supporting health workers after pilot course training through onsite mentoring support and advocacy for service uplift in these units to support roll-out. We are working with training partners for roll-out of training in Addis Ababa and nationally, with potential for piloting in other settings too. 

Global Clubfoot Initiative are leading dissemination of the final course materials and coordinating support for roll-out of the training on behalf of the project partners. Please contact for more information. The course materials are available in English, with Amharic translation of some components.


The results of our baseline survey of management of older children with clubfoot was published in September 2023  in IJERPH : Treating Older Children with Clubfoot: Results of a Cross-Sectional Survey of Expert Practitioners

Related Links


In the media

SURG-Africa interview with Prof Chris Lavy