Training At MiracleFeet: Building a Global Force to Eliminate Untreated Clubfoot

This month we are delving into the importance of training in clubfoot treatment.

Training is essential in the fight against untreated clubfoot, especially in low-resource settings. While in high-resource countries like the UK, clubfoot is routinely treated soon after birth, the same cannot be said for many low- and middle-income countries. These regions often suffer from a lack of access to treatment due to the scarcity of trained health workers proficient in the Ponseti Method. By increasing the number of trained providers, in time we can bridge this gap and ensure that every child – regardless of where they are born – receives treatment.

Qualified health workers are at the heart of MiracleFeet’s mission to eliminate clubfoot disability worldwide. Increasing the number and availability of trained providers is central to our model of expanding sustainable access to treatment.

MiracleFeet is committed to educating new providers in Basic and Advanced Ponseti skills, and by developing regional teams of qualified trainers who can grow workforce capacity in their own countries—an approach that reduces costs and increases much-needed access.

The Ponseti Method, a low-cost, non-surgical treatment for clubfoot, is perfectly suited to scaling in low-resource settings as it requires only basic supplies. It is well-documented that allied health professionals, such as physical therapists and casting technicians, can be proficiently trained in this technique. This supports task-sharing with orthopaedic surgeons to address the acute shortage of qualified health workers in many regions of the world.

Training curriculum:

Treating clubfoot is highly tactile: taking a Pirani score, manipulating the foot, applying casts correctly, and fitting the foot abduction brace are all skills that improve with practice. The ACT Program, originally launched as the Africa Clubfoot Training, is a standardised curriculum designed specifically for learning and applying these skills in low-resource settings. The curriculum combines theoretical learning with practical skill development, first with clubfoot models and then closely supervised with patients. The ACT package includes Basic, Advanced, and Train the Trainer courses, and has been successfully delivered around the world in English, French, and Spanish.

The ACT curricula have been extensively tested over several years and are widely considered the most comprehensive and practical set of Ponseti training available.

To supplement the hands-on training providers receive using ACT, MiracleFeet developed a digital version of the ACT curriculum, ACT Online, in partnership with OpenPediatrics at Boston Children’s Hospital. This eLearning platform enhances training outcomes and serves as a critical reference for new and experienced providers while reducing the cost of training. MiracleFeet also designed the world’s first 3-D interactive simulation of a clubfoot, allowing trainees and Ponseti practitioners to learn key concepts and practice foot manipulation in advance of and following in-person training.

Training milestones:

This year, MiracleFeet facilitated training for over 912 health workers at 92 courses around the globe. These included four flagship Train the Trainer courses in Ecuador, Sri Lanka, Uganda, and Senegal where, collectively, 42 experienced clinicians in 20 countries learned skills to train others in the Ponseti Method. In addition to teaching trainers, MiracleFeet partners delivered 53 basic, 25 advanced, and 10 refresher trainings this year.

Another tremendous training milestone was achieved through MiracleFeet’s recent partnership with PAHO — the World Health Organization’s (WHO) regional office of the Americas. Together we launched a free and open-access virtual course for frontline healthcare workers highlighting the importance of early identification and treatment of clubfoot. To date, over 4,500 health workers around the world have completed the course.

To learn more about MiracleFeet’s innovative training approach, please visit: https://www.miraclefeet.org/training-innovations.