Clubfoot treatment with Ponseti method—parental distress during plaster casting

Abstract

Background: Clubfoot is one of the most prevalent musculoskeletal congenital defects. Gold standard treatment of idiopathic clubfoot is the conservative Ponseti method, including the reduction of deformity with weekly serial plaster casting and percutaneous Achilles tenotomy. It is well known that parents of children with severe and chronic illnesses are mentally stressed, but in recent studies regarding clubfoot treatment, parents were only asked about their satisfaction with the treatment. Largely unknown is parental distress before and during plaster casting in clubfoot. Therefore, we want to determinate first, how pronounced the parents' worries are before treatment and if they decrease during the therapy. Second, we hypothesized that parents faced with an extreme deformity (high Pirani score), reveal more distress, than parents whose children have a less pronounced deformity (low Pirani score). Therefore, we wanted to investigate whether the Pirani score correlates with the parents' mental resilience in relation to the therapy of the child as a global distress parameter. Methods: To answer this question, we developed a questionnaire with the following emphases: Physical capacity, mental resilience, motion score, parents score, and child score with point scores 1 (not affected) to 6 (high affected). Subsequently, we interviewed 20 parents whose children were treated with clubfeet and determined the Pirani score of the infants at the beginning (T 0) and at the end (T E) of the treatment with plaster casting. Results: High values were obtained in child score (Mean (M) = 3.11), motion score (M = 2.63), and mental resilience (M = 2.25). During treatment, mental resilience improved (p = 0.015) significantly. Spearman correlation coefficient between Pirani score (T 0) and mental resilience (T 0) is 0.21, so the initial hypothesis had to be rejected. Conclusion: The issues of the children are in the focus of parental worries concerning clubfoot treatment, especially the assumed future motion and the assumed ability to play with other children. Particular emphasis should be placed on educating parents about the excellent long-term results in the function of the treated feet especially as this topic shows the greatest parental distress.

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

“…The other particularity of this intervention during period II was the application of a patient-centered and family-centered method of collaborative care. Indeed, the disorder and its treatment were even discussed during prenatal consultations when the team attempted to identify parents’ concerns and build positive relationships with the families 17 . The Ponseti method’s benefits were explained and emphasized in comparison with the previous technique (posteromedial release).…”

“…The Ponseti method’s casting phase consists of several manipulations and long leg-casting 17 . Serial casting is done with above-the-knee casts, as below-the-knee casts cannot maintain the foot’s abduction and external rotation.…”

The impact of socio-economic factors on parental non-adherence to the Ponseti protocol for clubfoot treatment in low- and middle-income countries: A scoping review

“… 4 , 11 , 12 It has been demonstrated to be cost-effective and easy to implement 13 , 14 but requires a strong engagement and resilience from parents as well as the affected child. 15 Non-adherence to the prescribed treatment protocol, including not wearing the brace as often as prescribed, leads to a 5–183-times increased risk of relapse of the deformity. 16 …”

“… 21 , 22 Prior studies identified barriers to access, treatment, and implementation of clubfoot programs in LMICs. 10 , 23 , 24 , 25 Considering that the Ponseti treatment requires a long-term commitment from the patient as well as the guardian, 15 identifying successful interventions that improve access to treatment is as important as identifying successful policies that help parents and children stay enrolled and finish treatment.…”

Evaluation of depression, anxiety, and stress status in parents of patient with congenital clubfoot treated with Ponseti method: A prospective study

“…In one of these studies, parents were asked to state their feelings about their child's foot deformity; another study examined the parents' stress and anxiety levels before and after treatment. [7,8] Unlike previous studies in the literature, the present study used the Depression Anxiety Stress Scale-21 (DASS-21). In the present study, we aimed to investigate the depression, anxiety, and stress status among parents of patients with congenital clubfoot before and after treatment with the Ponseti method.…”