Executive Summary
Clubfoot continues to threaten the mobility, function, and quality of life of infants and children in the Philippines. This CPG for clubfoot aims to provide evidence-based recommendations to healthcare professionals, policymakers, and public health officials regarding the screening and management of clubfoot among children. This updated Clinical Practice Guideline was developed to address key areas of uncertainty and practice variation identified through stakeholder consultation and systematic evidence review. The guideline focuses on ten priority questions spanning the continuum of care—from routine newborn screening and early conservative management to treatment escalation, relapse management, and long-term monitoring. By applying a transparent, rigorous methodology aligned with Department of Health standards and the GRADE Evidence-to-Decision framework, these guidelines aim to provide clear, actionable recommendations that balance evidence, feasibility, equity, and patient and caregiver values.
The Philippine National Clubfoot Council (PNCC) commissioned the Foundation for the Advancement of Clinical Epidemiology to review all relevant scientific literature and shepherd the completion of a Clinical Practice Guidelines on Clubfoot Management in the country. The group strictly stuck to the guides and parameters set by the country’s Department of Health in the construction of a CPG. Membership in the different committees were rigorously vetted to minimize if not eliminate completely biases and conflicts of interest. The consensus panel consisted of representatives from many societies and organizations with stake in clubfoot treatment. Parent advocate, patient advocate, physical therapist, social worker and orthotist were also part of the panel. These steps were taken to ensure that the output would be useful and acceptable to all.
Evidence review experts conducted systematic reviews of current best available evidence and assessed the certainty of evidence using the GRADE approach. A multidisciplinary guideline panel formulated the recommendations during an en banc, face-to-face guideline panel meeting. When high-quality evidence was lacking but guidance was warranted, good practice statements were provided. The absence of large randomized controlled trials—largely infeasible for clubfoot given its congenital nature, established effectiveness of conservative treatment, and ethical and logistical constraints of long-term randomization—contributed to most bodies of evidence being rated as low or very low certainty. Recommendations were tailored specifically to the Philippine healthcare context, considering resource constraints and population specific factors.
This CPG presents recommendations addressing ten (10) priority guideline questions on screening, treatment, monitoring, and relapse management of clubfoot. A total of ten (10) guideline recommendations were issued, comprising nine (9) strong recommendations and one (1) weak recommendation, alongside nine (9) Good
Practice Statements formulated in areas where direct comparative evidence was limited but guidance is necessary for safe and effective practice and the panel has high confidence that the desirable effects clearly outweigh the undesirable effects, despite the absence of direct evidence suitable for formal grading. In addition, one (1) consensus statement was issued to highlight an identified system-level gap related to locally produced foot abduction braces.
The guideline highlights key research gaps, including the need for high-quality local data and operational research to evaluate the effectiveness, feasibility, and implementation of recommended interventions. Despite limitations in the evidence base, the guideline provides comprehensive, contextually appropriate recommendations to inform clinical and public health responses to clubfoot in Filipino children.
This CPG offers standardized, evidence-informed guidance for managing clubfoot in the Philippines. The guideline will be updated as new evidence emerges or as significant changes in disease trends or epidemiology occur, to ensure continued relevance, scientific accuracy, and responsiveness to public health needs.
The Philippine National Clubfoot Council (PNCC) commissioned the Foundation for the Advancement of Clinical Epidemiology to review all relevant scientific literature and shepherd the completion of a Clinical Practice Guidelines on Clubfoot Management in the country. The group strictly stuck to the guides and parameters set by the country’s Department of Health in the construction of a CPG. Membership in the different committees were rigorously vetted to minimize if not eliminate completely biases and conflicts of interest. The consensus panel consisted of representatives from many societies and organizations with stake in clubfoot treatment. Parent advocate, patient advocate, physical therapist, social worker and orthotist were also part of the panel. These steps were taken to ensure that the output would be useful and acceptable to all.
Evidence review experts conducted systematic reviews of current best available evidence and assessed the certainty of evidence using the GRADE approach. A multidisciplinary guideline panel formulated the recommendations during an en banc, face-to-face guideline panel meeting. When high-quality evidence was lacking but guidance was warranted, good practice statements were provided. The absence of large randomized controlled trials—largely infeasible for clubfoot given its congenital nature, established effectiveness of conservative treatment, and ethical and logistical constraints of long-term randomization—contributed to most bodies of evidence being rated as low or very low certainty. Recommendations were tailored specifically to the Philippine healthcare context, considering resource constraints and population specific factors.
This CPG presents recommendations addressing ten (10) priority guideline questions on screening, treatment, monitoring, and relapse management of clubfoot. A total of ten (10) guideline recommendations were issued, comprising nine (9) strong recommendations and one (1) weak recommendation, alongside nine (9) Good
Practice Statements formulated in areas where direct comparative evidence was limited but guidance is necessary for safe and effective practice and the panel has high confidence that the desirable effects clearly outweigh the undesirable effects, despite the absence of direct evidence suitable for formal grading. In addition, one (1) consensus statement was issued to highlight an identified system-level gap related to locally produced foot abduction braces.
The guideline highlights key research gaps, including the need for high-quality local data and operational research to evaluate the effectiveness, feasibility, and implementation of recommended interventions. Despite limitations in the evidence base, the guideline provides comprehensive, contextually appropriate recommendations to inform clinical and public health responses to clubfoot in Filipino children.
This CPG offers standardized, evidence-informed guidance for managing clubfoot in the Philippines. The guideline will be updated as new evidence emerges or as significant changes in disease trends or epidemiology occur, to ensure continued relevance, scientific accuracy, and responsiveness to public health needs.
Summary of Recommendations
Routine screening for foot deformities
Q1: Should routine screening for foot deformities (e.g., clubfoot) be conducted for all newborns by primary care providers, such as midwives, nurses, pediatricians, and family physicians?
| No. | Recommendations | Certainty of Evidence | Strength of Recommendation |
| 1.1 |
We recommend routine newborn screening* for foot deformities by physical examination of primary care providers. *Remarks: Screening should be performed using a standardized checklist as part of the Philippine Expanded Newborn Screening Program. Imaging studies are not required. |
⨁◯◯◯ Very Low |
Strong |
| 1.2 |
Primary care providers should be trained regarding the proper |
None | Good Practice Statement |