SLR - April 2022 - Patrick M. Bik
Reference: Hu W, Ke B, Niansu X et al. Factors Associated with The Relapse in Ponseti Treated Congenital Clubfoot. BMC Musculoskelet Disord. 2022; 23: 88.Level of Evidence: Level III
Scientific Literature Review
Reviewed By: Patrick M. Bik, DPM
Residency Program: Temple University Hospital – Philadelphia, PA
Podiatric Relevance: Ponseti casting is used by podiatrists to treat congenital clubfoot deformity. It is the gold standard for congenital clubfoot treatment. It is important for podiatrists to be aware of various factors that can be associated with clubfoot relapse during treatment with Ponseti casting. The primary aim of this study was to seek the factors that lead to clubfoot relapse after using the Ponseti casting method.
Methods: This was a retrospective study of 148 patients with a total of 164 feet who were treated for congenital clubfoot deformity at a single hospital between June 2008 to June 2013. The inclusion criteria consisted of patients with untreated atypical clubfoot who underwent Ponseti casting with a minimum follow-up period of five years. Exclusion criteria consisted of patients with clubfoot secondary to arthrogryposis multiplex congenita or cerebral palsy, patients who were treated by non-Ponseti casting, and patients who were treated with surgery. Data collection included patient age, gender, initial Pirani score, number of casts, number of feet (unilateral or bilateral), age at the first casting, age of mother, tenotomy, walking age, and bracing compliance. The relapse rate was recorded and multivariate regression analysis was used to identify independent factors for prediction of relapse.
Results: One hundred forty-eight patients with a total of 164 feet underwent Ponseti casting. Sixty-four children presented with left-sided clubfoot, 58 with right-sided clubfoot, and 26 with bilateral clubfoot. Mean age at the first casting was 2.50 ± 2.15 months. Average initial Pirani score was 4.98 ± 1.33. Average number of casts was 5.71 ± 2.28. Mean age of mothers at birth was 25.81 ± 2.38 years old. Walking age of children had a mean of 14.83 ± 1.18 months. One hundred thirteen feet (76.4 percent) had a tenotomy performed. Forty-nine cases could not tolerate using braces. The noncompliance rate was 33.1 percent. Average follow-up was 7.27 ± 1.29 years. At the end of follow-up, the rate of relapse calculated was 21.6 percent. Regarding bracing, relapse rate in the noncompliant group was significantly higher compared to the compliant group (55.10 percent versus 5.15 percent). Following multivariate regression analysis, three independent factors to predict relapse after treatment with Ponseti casting were identified: age at first casting, initial Pirani score, and compliance with using bracing.
Conclusions: The authors concluded that the main risk factors for congenital clubfoot relapse after treatment with Ponseti casting are age at first casting, high Pirani scores, and noncompliance with foot abduction bracing. They found no correlation with regards to gender, number of casts, side of involvement, tenotomy, age of mother, or walking age.