Effect of Cultural Factors on Outcome of Ponseti Treatment of Clubfeet in Rural America

Avilucea, Frank R.; Szalay, Elizabeth A.; Bosch, Patrick; Sweet, Katherine; Schwend, Richard M.

doi:10.2106/jbjs.h.00580

Cited by 76 publications

(102 citation statements)

References 17 publications

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“…This correlation was found in Cape Town and Bali and Sumatra and confirms similar findings in Asia [18,20], Africa [15] and the Americas [14,21], where physical accessibility is described as a barrier for the Ponseti treatment as well. Specialized clubfoot clinics in rural areas are previously proven as a solution for overcoming this barrier [8,22].…”

Section: Discussionsupporting

confidence: 86%

“…In Cape Town there was a shuttle service from the clinic to the closest train station (1.5 km uphill), which helped parents to access the clinic. The travel duration also has an influence on follow up; the likelihood of decreased compliance to the bracing protocol is greater when caregivers have to travel a long time to the hospital, resulting in higher relapse rates [14]. Especially in the low-and middle income setting, relapse means an extra heavy burden on the family and the healthcare system after all the investments in the treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Especially in places where internet access is uncommon, for caregivers word of mouth information is an important way of gathering information about clubfoot. Publications from other countries emphasize on this aspect of the treatment as well [14,18].…”

Section: Discussionmentioning

confidence: 99%

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Feasibility and barriers of treating clubfeet in four countries

Wijck

Oomen²,

Heide

2015

International Orthopaedics (SICOT)

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Purpose The purpose of this study was to elucidate why neglected clubfeet still exists despite the availability of a highly (cost)-effective treatment-the Ponseti treatment. Methods A qualitative and partly quantitative study with semi-structured interviews was conducted in four countries: the Netherlands, South Africa, Argentina and Indonesia with both caregivers, mostly parents, of children with clubfoot and practitioners treating clubfoot. The topics discussed with the caregivers (n=51) were the conceptions of the cause of clubfeet, received information, accessibility, financial aspects, and social stigma. With the practitioners (n=11) the focus of the interviews was the treatment protocol and finance. Results Several barriers towards the start of the treatment were highlighted. At all places treatment was financed by the government, insurance or charity. Nevertheless, the cost of transport and missed working days formed a barrier, although there is a large difference between and within countries. Poverty, long travel duration, and beliefs of supernatural causes for the clubfoot result in delay in the start of treatment. Conclusion These are problems we need to address when making effective treatment available for every child to diminish the burden of neglected clubfoot; especially accessible clinics in rural areas can be a good alternative to highly specialized hospitals in large cities. We as a community should try to find and overcome the barriers to treat these patients, because we have a relatively easy and highly costeffective treatment option which can be given by trained nonphysicians supervised by an interested medical doctor.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

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Feasibility and barriers of treating clubfeet in four countries

Wijck

Oomen²,

Heide

2015

International Orthopaedics (SICOT)

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“…Factors such as initial disease severity, age of starting treatment, previous treatment, total casts required, tenotomy, gender, family history of clubfoot, and social status, which were suggested as possible influences were shown have no influence on recurrence [8,15,[17][18][19][20][21].…”

Section: Discussionmentioning

confidence: 99%

“…Compliance with brace has been identified as the most important factor influencing recurrence [5,4,7,14,18,19,[21][22][23][24][25][26]. Morcuende et al reported in a study that noncompliant group had an 80% recurrence when compared to only 6% recurrence in compliant group.…”

Section: Discussionmentioning

confidence: 99%

Steenbeek Foot Abduction Brace for Clubfoot: Cost Effective but Is It Effective? A Prospective Study

Dinesh

Kotian

2017

Asian J Pharm Clin Res

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Objectives: To evaluate the effectiveness of Steenbeek FAB (SFAB) to maintain correction achieved and to study the reasons for failure and complications associated with the brace. Methods:In Kasturba Medical College, Mangalore and allied hospitals between June 2014 and August 2016 25 patients (38 feet) who were treated by Ponseti method of cast application were given the SFAB and followed up for a minimum duration of 1 year. The status of the foot was assessed using Pirani score before brace application and at every follow-up. Compliance with the brace protocol was assessed and compliance defined as brace application for 23 hrs/day for the first 3 months, and nap time brace application for rest of the duration of study. Results:In 36 of 38 feet on the brace the correction was maintained (94.7% effective). In two patients (feet) there was worsening of the Pirani score after brace application and recurrence was seen. The reason for failure was found to be noncompliance. The correlation between noncompliance and recurrence was significant (p<0.001) using Fischer exact test. Pirani score improved significantly in a compliant group with significant worsening noted in noncompliant group. There were no other brace related complications. Conclusions:The significant correlation between noncompliance and recurrence shows that SFAB is effective in maintaining correction and can be a cost-effective alternative to the more costly braces, for use in developing countries.

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Clubfoot

Vergun¹,

Moskal²

2021

Evidence‐Based Orthopedics

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Effect of Cultural Factors on Outcome of Ponseti Treatment of Clubfeet in Rural America

Cited by 76 publications

References 17 publications

Feasibility and barriers of treating clubfeet in four countries

Feasibility and barriers of treating clubfeet in four countries

Steenbeek Foot Abduction Brace for Clubfoot: Cost Effective but Is It Effective? A Prospective Study

Clubfoot

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