Bridging the Gap in Clubfoot Care: A Framework for Sustainable Rehabilitation in Low-Resource Settings

Clubfoot is one of the most common congenital musculoskeletal deformities and remains a major cause of preventable childhood disability in low- and middle-income countries. In Pakistan, access to timely, standardized clubfoot care is limited, particularly outside major urban centers, resulting in delayed treatment and preventable lifelong disability. This technical report describes the development, evolution, and operational components of a sustainable clubfoot care and rehabilitation model established in Gujrat, Pakistan, beginning in 2010. The program transitioned from a single-room outpatient clinic into a comprehensive rehabilitation hub delivering Ponseti-based correction, prosthetic and orthotic services, physiotherapy, and structured long-term follow-up. Over 2,000 patients were enrolled, generating approximately 20,000 cumulative patient encounters. The model emphasizes phased infrastructure development, locally trained multidisciplinary workforce capacity, longitudinal service delivery, and financial sustainability through hybrid social enterprise mechanisms. Functional outcomes included independent ambulation, school participation, pain-free mobility, and workforce reintegration. This framework demonstrates that sustainable disability reduction in resource-constrained settings can be achieved through locally led, capacity-aligned system development and may serve as a replicable model for similar contexts.