The Burden of Lower Limb Deformities in Low- and Lower-Middle-Income Countries: A Scoping Review

Musculoskeletal (MSK) conditions like lower limb deformities significantly contribute to the global burden of disease. Low-income countries (LICs) and lower-middle-income countries (LMICs) are disproportionately affected, yet specifics surrounding MSK conditions in these regions remain largely unquantified. This scoping review seeks to (1) assess the epidemiologic information currently available for lower limb deformities in LICs and LMICs, including etiology and treatment, as well as (2) examine the individual, societal, and socioeconomic impact of these conditions. A scoping review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines searched PubMed, Embase, and Web of Science databases for studies published between 2012 and 2022 in LICs and LMICs containing statistics and epidemiological data quantifying the prevalence of lower limb deformities and/or providing sociological or economic analysis of the burden of those deformities. Forty-two studies of the original 3476 screened were included in this review. The studies, spanning 51 different LICs and LMICs, were primarily cross-sectional (n = 19) in design. Most studies had level IV evidence (n = 27, 64%). Trauma was the most common reported etiology of lower limb deformity (60%), clubfoot the most often reported congenital condition (75%), and amputation the most common reported treatment (67%). Less than half of included studies (n = 18, 43%) investigated disease burden utilizing either quality-adjusted life years or disability-adjusted life years, employment level, functional outcomes, psychological/interpersonal impact, and/or access to care. Despite the high prevalence of lower limb deformities in LICs and LMICs, associated epidemiological and disease burden data remain limited. Available studies broadly categorized sequelae of MSK injuries with limited information on treatment outcomes. Amputation was the most commonly mentioned surgical treatment despite the potential societal stigma regarding amputees. Even fewer studies explored the burden of MSK conditions impacting quality of life. A deeper understanding of the prevalence and impact of specific MSK conditions in LICs and LMICs will provide actionable data to inform a more comprehensive, locally relevant, and sustainable approach to managing lower limb deformities in resource-challenged environments.

(1)Lower limb deformities from a variety of congenital and acquired etiologies can impact patients from birth, including their physical and psychosocial well-being and function in society.(2)Lower limb deformities are especially impactful in the setting of low-income countries (LICs)/lower-middle-income countries (LMICs) where adaptive, surgical, and prosthetic options can be limited, and there is a dearth of data on the exact epidemiology of these deformities that limits the ability to calculate specific prevalence or incidence by country.(3)More granular and standardized data collection and distribution is needed on the epidemiology and burden of lower limb deformities in LICs/LMICs in order to inform policies aimed at increasing access to care, preventing, and treating such deformities as well as to better allow for analysis and quantification of the burden of disease on a socioeconomic and individual level.