Factors associated with the relapse in Ponseti treated congenital clubfoot

Abstract

Objectives We retrospectively investigated the clinical materials to seek the factors that lead to relapse after using the Ponseti method. Methods We retrospectively reviewed all children with congenital clubfoot treated with the Ponseti method in our hospital from June 2008 to June 2013. The data included the following factors: age, gender, initial Pinari score, number of casts, number of feet (unilateral or bilateral), age at the first casting, age of mother, tenotomy, walking age, and compliance with using bracing. All investigations were conducted in conformity with ethical standards. This study was approved by Guilin Peoples’ Hospital Ethics Committee. Results In this study, there were 148 cases (164 ft) in total that underwent the Ponseti method, with the follow–up period at least 5 years. Of them, 64 children presented with left side, 58 with right side, and 26 with bilateral cases. This study included 75 males and 73 females; sex did not affect the outcomes. The mean age of the first casting was 2.50 ± 2.15 months. The average initial Pirani score was 4.98 ± 1.33, and the average number of casts was 5.71 ± 2.28 times. The mean age of mothers at birth was 25.81 ± 2.38 years old. The walking age of children was at a mean of 14.83 ± 1.18 months. Forty-nine cases could not tolerate using braces, namely the rate of noncompliance in this study was 33.1%. Tenotomy was performed on 113 ft (76.4%). The average follow–up period was 7.27 ± 1.29 years (from 5 to 10 years). The rate of relapse was 21.6% (32 cases) at the end of the follow-up. The rate of relapse in the noncompliance with using bracing group was significantly higher compared to the compliance group . Conclusion The initial Pirani score, compliance with the foot abduction brace and the age at the first casting are three independent factors for relapse in clubfoot.

Club foot management in the Bafoussam Baptist Healthcare center (BBHC), Cameroon: Treatment outcomes and the associated factors of relapse with the Ponseti’s technique

“…However, a common question that is usually raised is, "What factors are associated with relapse?" [34]. In our study we found a relapse rate of 9.1%.…”

A 5-years results of the Ponseti method in the treatment of congenital clubfoot: a retrospective study

“…Non-compliance with post tenotomy bracing, educational level (less than high school) of parents, inaccess of the parents to the internet were some of the factors that affect outcome after the use of the Ponseti method for the management of idiopathic clubfoot while age and sex of the patients was not found to have a significant effect on the recurrence of the deformity [ 10 ]. The initial Pirani score, compliance with the foot abduction brace and the age at the first casting are three independent factors for relapse in clubfoot [ 11 ]. Non-compliance and the educational level of the parents (high-school education or less) are significant risk factors for the recurrence of clubfoot deformity after correction with the Ponseti method [ 12 ].…”

Gait Analysis Characteristics in Relapsed Clubfoot

“…Most studies focus on relapse before age 4 3,8,11–13. Fewer have reported on relapse in later childhood 4,7,14,15. In addition, little research has focused on late relapse, comparing those treated with the Ponseti method with those treated with joint sparing and joint invasive surgeries after initial casting treatment.…”

“…3,8,[11][12][13] Fewer have reported on relapse in later childhood. 4,7,14,15 In addition, little research has focused on late relapse, comparing those treated with the Ponseti method with those treated with joint sparing and joint invasive surgeries after initial casting treatment. The purpose of this study was to compare gait characteristics of children with late clubfoot relapse (defined as ≥ 5 y of age) following treatment with the Ponseti method compared with intra-articular (posteromedial release) and extra-articular (joint sparing) surgery.…”

“…6 Relapse of deformity after initial correction of idiopathic clubfoot, including Ponseti casting, has been reported with rates ranging between 19% and 68%. [3][4][5][7][8][9][10][11] Most studies focus on relapse before age 4. 3,8,[11][12][13] Fewer have reported on relapse in later childhood.…”