Bracing in Ponseti Clubfoot Treatment

Abstract

Clubfoot is the most common musculoskeletal birth defect, characterized by abnormal tendon and muscle development, leading to abnormal bone alignment of the feet. The Ponseti method is considered the gold standard in clubfoot treatment, and consists of a series of plaster castings, followed by 4 years of brace use. The most common cause of clubfoot relapse is nonadherence with the bracing protocol by the child's caretakers. The purpose of this study was to design, implement, and evaluate an educational bracing program for parents of children with clubfoot in an effort to improve bracing adherence. The educational bracing program for parents of children with clubfoot was designed with incorporation of findings from previous research, adult teaching methodology, and parental feedback. An educational brochure and a practice doll were created for use in educational sessions with parents during routine treatment visits. Two educational sessions were conducted with a health educator, employing identical questionnaires to assess changes in parental knowledge and skills upon completion of the program. Thirty parents completed the educational bracing program, and the majority reported increased knowledge and self-efficacy regarding the bracing protocol of the Ponseti method. In addition, the health practitioners who conducted the educational sessions witnessed an improved ability of all parents to apply the brace as directed, and to recognize and correct improper fit. Completion of the educational program by the parents resulted in immediate improvements in knowledge and skills related to clubfoot bracing. Given that noncompliance to the bracing protocol is the most common cause of clubfoot relapse, these immediate effects of the educational program are promising not only because they encourage proper brace use, but because these immediate improvements have the potential to reduce future rates of clubfoot relapse.

The Importance of Having a Single, Dedicated Medical Team to Treat Congenital Talipes Equinovarus Using the Ponseti Method: A Retrospective Analysis of Treatment Outcomes After 3 Years of Follow-up

“…6,[12][13][14] Indeed, good communication with the family is essential to establishing a trusting relationship and being able to influence their behavior, educate them about the disorder, and ensure that they are the principal partners in their child's treatment. 24 These ideas are all in line with the patient-centered and family-centered collaborative care model in pediatric orthopaedics. 25,26 The relaxing music played during cast room procedures could also partially explain the better clinical outcomes in period II, thanks to the reduced level of anxiety that makes the casting process more pleasant for medical teams, patients, and families.…”

“…The continuity of care ensured by having a single dedicated medical team for treating clubfoot—and the consequent learning curve that they will follow by repeatedly using this method—should also improve communication with families and their trust in those surgical teams 6,12–14 . Indeed, good communication with the family is essential to establishing a trusting relationship and being able to influence their behavior, educate them about the disorder, and ensure that they are the principal partners in their child’s treatment 24 . These ideas are all in line with the patient-centered and family-centered collaborative care model in pediatric orthopaedics 25,26 …”

Barriers and facilitators to lower extremity orthotic compliance in the pediatric population: A scoping review of the literature

“…written guidelines, pamphlets, and videos). 66,71,79,80 Furthermore, good parental education about the importance of orthotic compliance was mentioned as a facilitator in seven articles. 21,28,33,50,61,75,81 These facilitators were in direct contrast to previously discussed barriers, highlighting the importance of orthotic-specific education and good communication from the healthcare team.…”

Bracing in clubfoot: Do we know enough?

“…These strategies promote and increased understanding of bracing importance, and the ability of families to adhere to the prescribed protocols. 37…”