Taking steps to a bright future

By OMESHNIE NAIDOO Time of article published Aug 31, 2015

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Charlene Manneson went into labour in the early hours of August 8, 2014.

Her second son, Chrizzielle, was born that day and recently celebrated his first birthday.

His first steps were an especially bigger milestone for Manneson and her family because he was born with both feet inverted.

“The sister who delivered him noticed his feet were turned inwards and upwards and she told me she suspected he had club foot.

“The joy of delivering a healthy baby was now mixed with worry and a feeling I still cannot describe. I had heard of club foot before, but never experienced it on a personal level. I was scared of the unknown for my son,” she said.

The single, unemployed mother was referred to a local government hospital where Chrizzy, as she calls her son, was diagnosed with bilateral club foot.

Club foot is the most common musculoskeletal birth deformity, affecting 200 000 babies each year, but many people are not even aware of the condition, what causes it, or how it is treated.

According to Karen Moss at NGO STEPS SA, there are almost 11 000 children born with club foot in southern Africa every year.

Chrizzielle’s treatment began when he was three days old.

The newborn was put into a cast called a back slab.

Manneson says for three months she saw little to no progress. The cast hurt, causing skin irritation, blistering and bruising.

“It felt as though Chrizzy would not rest for more than 15 minutes at a time. He was constantly screaming himself to sleep and would not want to be put down by himself. It reached a point where I would cry with him. I felt so helpless.”

After hearing Moss on Carte Blanche, she decided to join the STEPS SA Facebook page.

“I voiced my concerns about my son’s progress and Karen responded.”

The back-and-forth e-mails between them are inspiring to read.

Karen found a doctor at Addington Hospital who would see Chrizzy and use the Ponseti method of putting on a cast.

Both women agreed that surgery might sound like a quick fix, but would only lead to more surgery.

“This doctor did in three weeks what I had not seen in three months,” Manneson said.

She said: “Going to malls with Chrizzy was an eye-opening experience. I would get a lot of stares and strange looks from people probably thinking I had done something to my child because both his legs had casts from his thighs to his toes. Only a handful of people would approach me to ask what happened or to confirm their theory that it was club foot.”

She said while the casts were still an irritation to the growing boy, especially in summer, she saw an incredible improvement.

“The final cast was put on when Chrizzy was six months old. The doctor did a tenotomy – a cut at the tendon to elongate it so Chrizzzielle would be able to stand. I will never forget that day and how he cried. I was not allowed in the room, but after half an hour he was fine and the cast was put on. This cast had to stay on for three weeks to allow the tendon to regenerate.”

She said: “When the casts came off, I couldn’t believe his feet looked normal. He would only get his Dennis Browne boots and bar (to keep the foot at a 70º angle in his case) the day after, and so for the first time in his life, my son went to bed without casts on.”

He had to keep the boots on for 23 hours a day. Only one hour was allowed for bath and free time.

“By the time three months had passed, Chrizzielle was being called skater boy as he would stand up on his boots and bar and slide across the front of the couches to get himself to where he wanted to be.”

The proud and knowledgeable mother said: “Children who don’t wear the boot as prescribed often relapse. Sleep is when children have the most growth spurts.

“So Chrizzielle must wear the boot for four years between 12 and 14 hours a day and he must wear it at night.”

Chrizzielle learnt to walk just before his first birthday.

“It is such a joy now to watch Malachi (her elder toddler) and Chrizielle play together,” said Manneson.

“Chrizzielle loves to follow his brother everywhere and knows he just has to point at something or cry and he will give it to him. He is finally sleeping for at least an hour in the day and does not scream when you put him down to change him any more (because he associated the action with the trauma of having casts on).”

She said now that Chrizzielle was over the most stressful parts of the journey, she could actively seek employment.

“One thing I firmly believe is if I were a lazy mother or did not follow the doctor’s instructions to the letter, we would not be where we are now. There were so many days I wondered how I would keep this up, but then I know I would rather go through all this now than when he is at a school and susceptible to being teased by peers.

“All I do is take it one day at a time, and enjoy the blessings of my boys in my life.”

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Where parents can seek support and advice

STEPS SA is an NGO focused on the treatment of club foot. It was founded by Karen Moss, whose son was born with the condition.

The organisation provides family support through online groups, social media, a bedtime storybook for kids in club-foot braces and a recycled brace programme for families with a limited or no health-care plan. It offers parents advice on treatment, connects them with doctors and clinics, and gives encouragement for their journey.

STEPS’s South African Ponseti training courses for club-foot treatment are well supported by paediatric orthopaedic surgeons and have significantly revolutionised treatment in South Africa.

The Ponseti method is endorsed by the South African Paediatric Orthopaedic Society.

After the successful introduction of Ponseti to South Africa, STEPS has also organised training courses in Namibia and Botswana, and works with local partners and stakeholders to build capacity for club-foot treatment in their countries.

For more information call 021 462 7357.

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How the Ponseti method of treatment works

The Ponseti method was devised more than 60 years ago by Dr Ignacio Ponseti. He avoided cutting the tight ligaments, tendons and joint capsules.

His method involves a carefully constructed sequence of plaster casts and braces for children with club foot, based on his studies of the condition.

The method takes about four to six weeks of plaster casts, changed every five to seven days. For more than 80% of cases, the tight Achilles tendon is cut in a minor procedure (a tenotomy) and the corrected foot is put in a holding cast for three weeks to allow the tendon to regenerate longer.

When the final cast is removed, a club-foot brace is fitted – a pair of shoes or boots attached to an adjustable bar at a specific width and angle. The child wears these at night for four years.

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