Clubfoot is one of the most common congenital musculoskeletal conditions worldwide, causing the foot to twist inward and downward. When treated early with serial casting, the Ponseti method can correct the deformity without major surgery. But in many rural communities across low- and middle-income countries, children arrive at clinics years or even decades late, their feet rigidly deformed by scar tissue, adapted bone structure, and years of walking on unusual surfaces. These neglected cases demand complex corrective surgery, followed by months of rehabilitation. What has often been missing from the global conversation is evidence on what such surgery actually delivers afterward, not just in anatomical correction but in the lived realities of children navigating school, family life, and community attitudes toward disability.

The research team designed a mixed-methods study to capture both numbers and narratives. Between July 2021 and June 2023, 194 children were treated across eight communities in the two regions, 84 for neglected clubfoot and 110 for other musculoskeletal deformities. The quantitative arm consisted of a cross-sectional post-treatment survey using a study-specific, pretested questionnaire. Satisfaction was measured on a five-point Likert scale, pain was assessed through structured categorical frequency questions, and additional outcomes included the ability to wear shoes of one’s choice, participation in social and school life, and the use of livelihood support provided to families. The qualitative arm comprised 16 key informant interviews and five focus group discussions involving 40 participants, allowing caregivers, community members, and program staff to describe in their own words how treatment had reshaped daily life.

The headline numbers are compelling. Overall, 174 participants, or 89.7 percent, expressed satisfaction with the treatment they received. When asked why, the dominant reason, cited by 56.2 percent, was the visible correction of the deformity itself, followed by pain-free walking at 13.44 percent. Functional gains were broad: 73.7 percent of children reported no pain while walking, 55.7 percent reported no pain even during heavy activity, and 76.8 percent could wear shoes of their own choosing. For children who had previously walked barefoot on twisted feet, or hidden their limbs beneath long garments to avoid ridicule, the ability to put on a normal pair of shoes is far more than a cosmetic milestone. It is a passport to social participation, and the survey data suggest families understood it exactly that way.

The qualitative interviews added depth that numbers alone cannot convey. Caregivers and community stakeholders described children who moved with greater mobility and independence, who carried themselves with new self-confidence, who returned to classrooms and playgrounds they had abandoned. Peer interaction increased, and the stigma that shadows visible disability in many communities visibly receded. Parents spoke of children who no longer needed to be carried or shielded, and of households freed from the constant logistical burden of caring for a child with limited mobility. These accounts, analysed thematically and integrated with the survey findings, reinforce a central point of the study: corrective surgery for neglected deformities is not merely an orthopedic intervention but a social one, with ripple effects across education, family economics, and community attitudes.

One of the most distinctive elements of the program evaluated in the study is its livelihood-support component, funded through the Socio-Economic Empowerment of Peoples living with disabilities initiative supported by Christian Blind Mission. Among 89 recipients of such support, 34.8 percent used the funds for transport to follow-up appointments, a practical but critical use in regions where clinics may be hours away and roads are poor. Other allocations included children’s basic needs at 21.3 percent, school fees at 16.9 percent, household food at 14.6 percent, and small business investments at 12.4 percent, alongside medical expenses such as medication and school supplies. The qualitative data echoed these patterns, with families reporting that support for medication, school materials, food, and household economic activities made it possible to sustain the long arc of treatment and recovery.

This finding carries an important lesson for global health. Surgical correction is a single event, but recovery is a months-long process requiring repeated clinic visits, physiotherapy, and consistent home care. In settings where a round-trip bus fare can consume a significant share of a family’s weekly income, even the most successful operation can fail in follow-up. By pairing clinical treatment with targeted socioeconomic assistance, the program addressed the economic determinants of adherence directly. The study’s authors suggest that such integrated models, combining treatment, rehabilitation, education, psychosocial support, and livelihood assistance, may be essential for strengthening long-term outcomes for children with musculoskeletal deformities, rather than treating surgery as an isolated technical fix.

The study is equally candid about the barriers that persist. Transport costs and long travel distances remained significant obstacles for families seeking follow-up care. Access to physiotherapy was limited, a serious constraint given that post-surgical rehabilitation determines how well corrected feet function over a lifetime. Gaps in follow-up itself were noted, meaning some children may not have received the sustained monitoring that complex corrections require. These challenges are not unique to Cameroon; they mirror the structural weaknesses of surgical care systems across many low- and middle-income countries, where workforce shortages, geographic dispersion, and out-of-pocket costs conspire to erode the gains of even excellent clinical work.

Methodologically, the study has the strengths and limits inherent to its design. The cross-sectional survey captures outcomes at a single point in time rather than tracking change longitudinally, and the questionnaire was study-specific rather than a validated generic instrument, which aids relevance but complicates comparison with other settings. Descriptive statistics were used, and the qualitative component, while rich, involved a modest number of participants. Yet the convergence of quantitative and qualitative evidence, with independent lines of inquiry pointing to the same conclusions about mobility, confidence, schooling, and stigma, lends the findings considerable credibility. The research was approved by the Cameroon Baptist Convention Health Services Institutional Review Board, and all participants provided written informed consent in accordance with the Declaration of Helsinki.

The broader significance of this work lies in its reframing of what success means in pediatric orthopedics for resource-limited settings. For decades, surgical missions and outreach programs have been evaluated by volumes of operations performed. This study demonstrates that the metrics that matter most to families, pain-free walking, ordinary shoes, school attendance, peer acceptance, and reduced stigma, are achievable at scale when surgery is embedded in a system of social and economic support. As the global health community intensifies its focus on equity in surgical care, the Cameroonian experience offers a template: correct the deformity, yes, but also fund the bus fare, the school fees, and the small business that keep a family engaged in care. In doing so, medicine does more than straighten feet. It opens doors that childhood disability had long kept closed.

Subject of Research: Post-treatment functional and social outcomes of corrective surgery for neglected clubfoot and other musculoskeletal deformities in children in rural Cameroon

Article Title: Post-treatment functional and social outcomes of corrective surgery for neglected clubfoot and other musculoskeletal deformities in two rural regions in Cameroon

Article References: Awa, J. C., Signang, A. N., Henry, N., Tamon, J., Neba, F. J., Eveline, M. K., Muffih, P. T., & Ngum, S. (2026). Post-treatment functional and social outcomes of corrective surgery for neglected clubfoot and other musculoskeletal deformities in two rural regions in Cameroon. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07752-z

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07752-z

Keywords: clubfoot, musculoskeletal deformities, corrective surgery, Cameroon, pediatric orthopedics, disability, stigma, school participation, livelihood support, mixed-methods research, global health, rehabilitation

The research, led by Cristina González-Martín and colleagues at the Universidade da Coruña in Spain, was conducted through international cooperation initiatives in two very different settings: the town of Sangmélima in the South Region of Cameroon, and a partnership with the Complexe Régional des Personnes en Situation d’Handicap in Azrou, Morocco. Rather than importing a short-lived medical mission, the team designed a model built on four complementary pillars: podiatric clinical assessment, health education, capacity building of local healthcare personnel, and referral and care coordination for complex cases. The aim was not only to treat feet but to leave behind a local system capable of continuing the work.

Participants were identified through collaborating healthcare, educational, and disability-support institutions, combined with community outreach activities that brought screening directly to the populations least likely to reach a clinic on their own. This institution-based identification plus outreach approach matters, because foot disorders disproportionately affect people who are already marginalized: children with congenital deformities, people living with neurological conditions, and individuals with disabilities who face physical, financial, and geographic barriers to care. In total, 545 participants were assessed over the programme period, 102 in Morocco and 443 in Cameroon, making this one of the larger descriptive datasets on community podiatric needs in these regions.

The clinical findings reveal two distinct epidemiological profiles. In the Moroccan cohort, neurological disorders were the most common comorbidity, affecting 43.1 percent of participants, a figure that reflects the partnership with a regional disability complex in Azrou. The most frequent podiatric findings were Achilles tendon contracture in 29.4 percent of participants, equinus foot in 28.4 percent, hindfoot valgus in 19.6 percent, and clubfoot in 9.8 percent. These are conditions in which the soft tissues and bony architecture of the foot and ankle become fixed in abnormal positions, often after years without intervention. An Achilles tendon contracture limits the ankle’s ability to dorsiflex, turning every step into a mechanical compromise; equinus foot, in which the foot is held in a downward position, forces compensations at the knee, hip, and spine.

Clubfoot, or congenital talipes equinovarus, deserves particular attention. It is one of the most common congenital musculoskeletal deformities worldwide, and when treated early with serial casting techniques such as the Ponseti method, most children walk normally. Untreated, however, the foot becomes rigidly inverted and adducted, and adults with untreated clubfoot often experience pain, callosities, difficulty with footwear, and profound social stigma. The fact that nearly one in ten assessed participants in Morocco presented with clubfoot underscores how a condition that is largely correctable in infancy continues to produce disability when access to early diagnosis and treatment is missing, a textbook illustration of health inequity expressed in the architecture of the foot.

The Cameroonian cohort in Sangmélima showed a different pattern. The most prevalent podiatric findings were metatarsus adductus in 12.9 percent of participants, a congenital or developmental inward deviation of the forefoot; claw toes in 7.0 percent, in which the toes curl downward at both joints and are prone to pressure lesions; gait adduction in 5.2 percent; clubfoot in 4.5 percent; and hindfoot valgus in 4.5 percent. Hindfoot valgus, an outward tilting of the heel, alters weight distribution across the foot and can lead to flatfoot deformity, plantar pain, and progressive joint wear. Claw toes frequently complicate conditions such as diabetes and neurological disease, where loss of intrinsic muscle balance deforms the toes and creates ulcer-prone pressure points.

From a biomechanical standpoint, the conditions documented in both countries share a common thread: they are progressive and time-sensitive. Soft tissue contractures respond to stretching, casting, orthoses, and minor procedures when addressed early, but become fixed deformities that require complex surgery when neglected. This is precisely why the study’s authors emphasize that insufficient healthcare infrastructure, shortages of trained professionals, and limited rehabilitation resources contribute to preventable disability and reduced quality of life. The clinical assessment component of the programme therefore functioned not merely as a diagnostic exercise but as a triage system, channeling complex cases into a referral and care coordination pathway while simpler problems could be managed through education and conservative measures.

The education and capacity-building components are arguably the most strategically important. The programme trained local healthcare personnel in podiatric assessment and basic management, aiming to embed foot health competencies within institutions that will remain in the communities long after international teams depart. Health education delivered to participants and families addressed hygiene, footwear, early warning signs, and the importance of seeking care before deformities become fixed. This dual investment in human capital and community knowledge is what distinguishes a sustainable health system intervention from a one-off surgical camp, and the authors argue that the model is potentially sustainable and replicable in similar resource-limited settings.

What makes the study notable for the global health community is its framing. Foot disorders are rarely counted among headline health inequities, which tend to focus on infectious disease, maternal mortality, or major non-communicable diseases. Yet mobility is the infrastructure of daily life, and the data from 545 individuals in Morocco and Cameroon give quantitative weight to a burden that has historically been invisible in national health statistics. The researchers used descriptive analyses to characterize participant demographics, comorbidities, and podiatric disorders, and the resulting profiles provide an evidence base that health ministries and non-governmental organizations can use to plan services, allocate rehabilitation resources, and justify investment in training programmes.

The authors conclude that the community-based podiatric health model was feasible to implement in resource-limited settings and provided an integrated approach combining clinical assessment, health education, workforce development, and referral coordination. No specific funding from public, commercial, or not-for-profit grant agencies supported the research, and the authors declare no competing interests. As with any descriptive implementation study, the findings document needs and demonstrate feasibility rather than proving long-term outcomes, and future work will need to track whether trained personnel retain skills, whether referred cases complete treatment, and whether disability outcomes improve. But the central message is clear and urgent: with modest, well-organized investment, the silent epidemic of untreated foot disease in underserved communities can be seen, measured, and treated, one community at a time.

Subject of Research: Community-based podiatric care and foot health equity in low-resource settings in Morocco and Cameroon

Article Title: Community-based podiatric health programme to improve access to foot care and strengthen local health capacity in Morocco and Cameroon

Article References: González-Martín, C., Barreiro, V. B., Garcia-Rodriguez, T., Fernandez-López, U., & Grela-Fariña, M. (2026). Community-based podiatric health programme to improve access to foot care and strengthen local health capacity in Morocco and Cameroon. International Journal for Equity in Health. https://doi.org/10.1186/s12939-026-03030-7

Image Credits: AI Generated

DOI: 10.1186/s12939-026-03030-7

Keywords: podiatry, health equity, global health, community health, capacity building, rehabilitation, clubfoot, Morocco, Cameroon, low-resource settings, foot care, disability