Extended Scope Physiotherapist in Paediatric Orthopaedics
Chelsea and Westminster Hospital NHS Foundation Trust
by Denise Watson
Meeting a new family with a child with Clubfoot always feels to me like the beginning of a journey. For some this turns out to be more complex than others, but I see that a large part of my role is to make the whole process as easy for the family as possible.
I am a paediatric physiotherapist working at Chelsea and Westminster Hospital in London with a special interest in Clubfoot and other lower limb deformity in children.
I love my job. I have worked here for 15 years and have a great team of colleagues who are motivated and proactive. We have been using ‘Ponseti’ method for more than 16 years and still marvel at how a simple solution can provide such good results.
I wouldn’t really say that any day can be classed as ‘typical’. One of the great challenges of working with children is that things may not (and probably won’t!) run to a plan. This results in a job that is both exciting and never boring!
We have a specialist Clubfoot service and run several Ponseti clinics during the week to see children at varying stages in the treatment process. We run two casting clinics a week and 3 to four follow up clinics. We are based in the Children’s outpatient unit, which is part of the Chelsea Children’s Hospital. Running a designated clubfoot service is great for the families attending, as they can compare notes and share tips in the waiting area. It really helps for new parents to see other families who are a little further through the process. I recently saw a couple for antenatal counselling, who got chatting to another family in the waiting area. By the time I called them in, they had few questions left to ask as the other parents had told them all there was to tell! We see patients from all over the UK and sometimes from abroad.
Clinics can be noisy and chaotic with many very young children and often slightly older children who may need a bit of coaxing or distraction in order to get casts off and back on!
Most of our Achilles tendon tenotomies are performed in clinic and the parents are given the choice of whether to stay with their baby as we do them. We have 2 paediatric orthopaedic consultants in our team who make the procedure look very straight forward and have a strong empathy with how stressful many families find this situation.
A lot of children with complex clubfoot are referred to us. Both atypical feet which may not have responded as expected to casting at their local hospital and have therefore been referred for a second opinion, or those with additional diagnoses or syndromes. It’s not always possible to get a perfect result with these feet but I will always give it my best shot. I like a challenge!
We follow our patients up until 8-10 years of age . It’s very sad to say goodbye to a family at the end of that time. I feel that we have often been through a lot together, but it’s wonderful to see many of our treated children participating in sports and activities alongside their peers. Last year we ran our first Clubfoot Football Club event with Chelsea FC . We watched 75 children participate in training and 5 aside games with the wonderful Chelsea coaches alongside their siblings. It was often hard to tell which children had initially been born with clubfoot. We are looking forward to running it again this year with up to 100 children.
I answer a large number of emails from anxious families who either have a new diagnosis of clubfoot from antenatal scan and or from families in the middle of treatment who want reassurance that their child is progressing in the expected way. I also keep in touch with many Physiotherapists and Allied Health Professionals from around the country who wants to discuss difficult cases. I really enjoy this aspect of my work and hope that I can offer reassurance and sound practical advice.
I have been fortunate enough to be involved in clubfoot training in other countries which include Bangladesh, Ethiopia, Kenya , Tanzania, Belarus and Vietnam. I feel that I have learnt so much from seeing feet that have been neglected of treatment, and the impact that that can have on the child and family .I am inspired by the dedication and perseverance of some of the doctors, physiotherapists, nurses and medical officers that I have met . Global Clubfoot initiativewww.globalclubfoot.com have worked with the University of Oxford and other organisations such as Miracle feet and CURE international to put together a wonderful training programme for Africa. I have been luck to be part of this and we now hope to use the course in the UK to provide excellent standardised training for all Ponseti Practitioners.
Steps Charity supports our work by producing excellent literature , chat rooms and helplines which are invaluable to our clubfoot families. They also promote awareness of clubfoot . We are very grateful for all that they do.