27 Jul A clubfoot programme to straighten feet and strengthen systems
Tina was born with her left foot twisted on its side.
Her family tried to help her using the knowledge and resources they had at the time. Her mother, Christina, took her to a traditional healer, who massaged Tina’s leg in the hope that it would straighten.
But nothing changed.
“So, I said, ‘Just leave it like that. It will recover once someone provides treatment’,” Christina explained, holding onto hope that one day her daughter would find healing.
Years passed. As Tina grew older, walking long distances remained painful. She could not wear sandals, and she often needed support to move from one place to another.
School did not feel possible when every step required help. So, Tina’s family made the difficult decision not to enrol her and kept her at home, uncertain of what her future might hold.
One in 800 babies born with clubfoot every year
Tina’s story reflects a broader reality in Madagascar. Clubfoot is one of the most common congenital conditions worldwide, and in Madagascar, the need for treatment is significant.
“[Globally], about one in every 800 babies is born with clubfoot [each year],” explains Nick Veltjens, a Mercy Ships volunteer physiotherapist and Clubfoot Mentoring Programme Manager. “That makes it about 1,200 babies each year in Madagascar.” With new cases emerging annually, the need for treatment continues to grow, making sustained support and expanded expertise essential.
A national clubfoot programme was established in Madagascar nearly a decade ago, resulting in clinics across the country and many babies and young children receiving early treatment. However, for older children who miss early care, the journey is longer, and the need remains.
“There is a very good national clubfoot programme here in Madagascar,” continues Veltjens. “But there’s still a big gap between the children who are born each year and the number that are being treated.”
Training local teams with the Ponseti method
Mercy Ships first began supporting clubfoot care in Madagascar in 2015, helping train local teams to treat young children using the Ponseti method, a gentle approach based on serial casting and careful correction.
“More than 3,000 children that we know of have been treated and healed from clubfoot here in Madagascar since 2015,” explains Dr Saholy Razafindranaly, a general practitioner and Ponseti trainer in Toamasina.
When the Africa Mercy left in 2016, the work continued through MiracleFeet, a charity that provides clubfoot treatment to children, in partnership with the Ministry of Health. Together, these efforts helped scale care nationwide and strengthen long-term treatment capacity.
Yet many children still did not have access to timely treatment. According to Dr Saholy, several challenges continue to affect access: too few specialised health workers, the long distances families must travel to reach treatment centres, and communities where people still believe clubfoot cannot be cured.
A treatment for Tina
When Mercy Ships returned to Madagascar in 2025, the focus was not on replacing what already existed but on strengthening it, especially for older children with delayed-presenting clubfoot.
“Many children miss early treatment,” says Veltjens. “When that happens, they grow older with untreated clubfoot, and the condition becomes more complex to manage.”
It was within this gap in care that Christina found the next step for Tina.
At CHU Analankininina, known locally as Hôpitaly Be, Mercy Ships had set up the Clubfoot Mentoring Project. There, Tina was selected for care.
Unlike earlier programmes focused on babies, this initiative addresses delayed-presenting clubfoot in children older than two, where treatment requires more time, careful planning and advanced skills.
The programme not only treats patients but also trains and mentors clinicians to become confident practitioners, future trainers and leaders.
Step by step, a new beginning
Tina’s treatment began with serial casting, the foundation of the Ponseti method. Each week, her foot was gently stretched and placed into a cast, gradually guiding it toward its correct position.
With older children, Veltjens explained, the process takes longer. Casting can continue for months, slowly stretching tight feet and reducing the need for more invasive surgery later. In Tina’s case, this careful preparation mattered.
“What we don’t want to do is jump straight to surgery,” he said. “What we want to do is slowly stretch the foot with the casts… to really correct the foot into a really good position so that the surgery that they need is just very minimally invasive.”
For the mentoring participants, each cast was also a lesson. The Ponseti method is hands-on. Proficiency requires repetition, precision and follow-up care.
And for some older children, even after casting, a procedure is still needed to complete correction and reduce relapse risk. That is why the programme also trains surgeons.
Dr Herinatolotra Onja Ramanamisata, a Malagasy surgeon with more than two decades of experience, described what changed for him through the training.
“Before… what we usually did for clubfoot was almost always surgery,” he said. “We noticed that it was difficult for patients… and sometimes we even had to redo the surgery when we relied only on surgery.”
Through the mentoring programme, he learned that “even for late-presenting clubfoot, the Ponseti method can still be applied.”
“And when surgery is eventually needed,” he explained, “the surgery becomes lighter and less complex.”
Dr Rachel Buckingham, a UK Mercy Ships volunteer paediatric orthopaedic surgeon, described the purpose behind the mentorship.
“A big part of the work of Mercy Ships is to train local health care professionals,” she says. “So that Mercy Ships becomes, hopefully in the future, unnecessary.”
She added that the Ponseti method is particularly suited for low-resource settings. “It’s not a very expensive thing to do… something that is sustainable,” she explains.
Multiplying knowledge
After surgery, Tina’s journey continued into its most delicate phase: rehabilitation. Strengthening, balance and long-term follow-up help protect what casting and surgery corrected.
For Dr Saholy, this stage reflects the deeper strength of the mentoring model. Mercy Ships not only provides care. “They also give training,” she says. “That means they don’t keep their knowledge to themselves, but they share it.”
She described what she hopes will come next.
“After this training… to be able to pass on that knowledge and skills we have received to other health care workers,” she says.
For Christina, the hope is simpler and more personal. Her little girl, who once needed help for every step, is moving toward a different future.
Tina’s foot has been straightened, and a system is being strengthened around her, so that when Mercy Ships sails away, children who once fell through the cracks can still find care in Madagascar.
Discover more about Mercy Ships’ training and mentoring programmes.