Reoccurrence rate in Ponseti treated clubfeet: A meta-regression

Wallace, Juanita; White, Hank; Eastman, Joel E.; Augsburger, Sam; Xi, Ma; Walker, Janet L.

doi:10.1016/j.foot.2019.03.002

Cited by 8 publications

(6 citation statements)

References 18 publications

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“…Recurrence rates in the literature have ranged from 11% to 83%. 24 Ponseti and Smoley 1 reported a 56% recurrence rate in their 5 to 12-year follow-up. A recent systematic review of long-term outcomes of the Ponseti method found recurrence rates of 47% with additional surgery required in 79% of recurrences.…”

Section: Discussionmentioning

confidence: 95%

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Prospective, Randomized Ponseti Treatment for Clubfoot: Orthopaedic Surgeons Versus Physical Therapists

Chen

Ragsdale

Rhodes

et al. 2022

Journal of Pediatric Orthopaedics

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Background: Clubfoot is a common congenital foot deformity in children. The Ponseti method of serial casting has become the standard of care in clubfoot treatment. Clubfoot casting is performed in many centers by both orthopaedic surgeons and physical therapists (PTs); however, direct comparison of outcomes and complications of this treatment between these providers is limited. This study prospectively compared the outcomes of patients with clubfoot treated by these 2 groups of specialists. Methods: Between January 2010 and December 2014, all patients under the age of 12 months with a diagnosis of clubfoot were included. Patients were randomized to an orthopaedic surgeon (MD) group or a PT group for weekly serial casting. Main outcome measures included the number of casts required to achieve correction, clinical recurrence of the deformity, and the need for additional surgical intervention. Results: One hundred twenty-six infants were included in the study. Patient demographics and characteristics (sex, race, family history of clubfoot, laterality, and severity of deformity) were similar between treatment groups, with the only significant difference being the mean age of entry into the study (5.2 weeks in the MD group and 9.2 weeks in the PT group, P=0.01). Mean length of follow-up was 2.6 years. The number of casts required trended to a lower number in the MD group. There was no significant difference in the rates of clinical recurrence or additional surgical intervention between groups. Conclusions: Ponseti casting for treatment of clubfoot performed by orthopaedic surgeons and PTs results in equivalent outcomes without any difference in complications. Although the number of casts required trended to a lower number in the MD group, this likely did not result in any clinical significance, as the difference in cast number equaled <1 week’s difference in the overall duration of serial casting. Level of Evidence: Level I—therapeutic.

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Section: Discussionmentioning

confidence: 95%

“…To capture all recurrent deformities, we chose a strict definition of recurrence as any increase in scores beyond the initial corrected values. Recurrence rates in the literature have ranged from 11% to 83% 24. Ponseti and Smoley1 reported a 56% recurrence rate in their 5 to 12-year follow-up.…”

Section: Discussionmentioning

confidence: 99%

Prospective, Randomized Ponseti Treatment for Clubfoot: Orthopaedic Surgeons Versus Physical Therapists

Chen

Ragsdale

Rhodes

et al. 2022

Journal of Pediatric Orthopaedics

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“…Alongside this, the average 3-year follow-up period is considered to be too short, because recurrence rates peak around 5 years post initial correction (Stouten et al 2018 ). Future studies should incorporate longer follow-up periods (> 5 years) and use randomized controlled, blinded study designs (Wallace et al 2019 ).…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors for recurrent idiopathic clubfoot deformity: a systematic literature review and meta-analysis

et al. 2021

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Background and purpose After initial clubfoot correction through Ponseti treatment, recurrence rates range from 26% to 48%. Even though various factors have been associated with increased recurrence risk, systematic assessments of the prognostic capacity of recurrence risk factors and their clinical relevance are lacking. Therefore we assessed clinically relevant prognostic factors for recurrent idiopathic clubfoot deformity after initial correction through Ponseti treatment. Methods PubMed, Embase, Cinahl, and Web of Science were systematically searched for studies investigating the association between clinically relevant factors and recurrence rates. Prognostic factors were qualitatively assessed and included in the meta-analysis if ≥ 2 studies investigated the same factor and methods were comparable. Results 34 articles were included in the qualitative synthesis, of which 22 were also included in the meta-analysis. Meta-analysis revealed that poor evertor muscle activity (OR = 255, 95% CI 30–2,190), brace non-compliance (OR = 10, CI 5–21), no additional stretching (OR = 31, CI 10–101), more casts (OR = 3.5, CI 1.6–7.8), lower education level of parents (OR = 1.8, CI 1.2–2.6), non-marital status of parents (OR = 1.8, CI 1.1–3.0), and higher Dimeglio scores (OR = 1.9, CI 1.2–3.3) were associated with higher recurrence rates. Interpretation Brace non-compliance and poor evertor muscle activity have been identified as main recurrence risk factors and are therefore important to be closely monitored during clinical follow-up of clubfoot patients. Adding additional stretching during the bracing protocol might be promising in the quest to prevent relapse, but scientific evidence for clear clinical treatment recommendations is still limited.

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“…The included studies had relapse rates ranging from 11 to 83%. 39 The authors used effect size statistics to infer that on an average 30% of patients will face a relapse over the years. Thomas et al (review period 1963Thomas et al (review period -2018 on their systemic analysis in their systemic analysis of 46 studies found the average relapse rate following Ponseti treatment to be 22.5%.…”

Section: Review Of Literaturementioning

confidence: 99%

“…30%) synchronized well with those calculated by other authors. 37,39 Relapses are inherent to clubfoot treatment by Ponseti technique. The same was recognized by Dr. Ponseti himself and the 1963 classic described deformity relapse in fifty-three feet (56%) at ages ranging from ten months to five years.…”

Section: Review Of Literaturementioning

confidence: 99%

Relapses in clubfoot treated with Ponseti technique and standard bracing protocol- a systematic analysis

Agarwal

Rastogi

et al. 2021

Journal of Clinical Orthopaedics and Trauma

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The analysis determined the relapses in clubfoot children treated with Ponseti technique and standard bracing protocol and their correlation with overall follow up duration using pooled data from various series. It also tested the prescribed timelines of 5 and 7 years for slow-down/cessation of relapses in clubfoot children. Methods: A systematic literature search was performed for articles published in "Pubmed (includes Medline indexed journals)" electronic databases using key words: "Clubfoot or CTEV or congenital talipes equinovarus", "Ponseti" for years 1 st January 2001 to 15 th November 2020. Included were studies that addressed treatment of idiopathic clubfoot using the standard Ponseti technique, followed a well defined brace protocol (maintenance of corrected deformity using a central bar based brace and prescribed duration mentioned), reported a minimum mean follow up of 4 years and having relapse as one of their outcome measure. Studies reporting Ponseti technique for non-idiopathic clubfoot, child's age older than 1 year at the time of primary treatment, clubfoot with previous interventions before Ponseti treatment, where relapse and residual deformities were not identified distinctly in follow up, abstract only publications, letter to the editors, case reports, technique papers and review articles were excluded. The following characteristics of clubfoot patients in the selected articles were included for analysis: Patient numbers/feet treated with Ponseti technique; follow up years (<5; 5-7 and >7 years; overall) and corresponding relapse percentages for patients. Results: There were total 2206 patients in the included 24 studies. Average follow up was 6 years. The average relapse rates for clubfoot patients in the pooled data stood at 30%. The overall relapse rates increased with a longer follow up and the curve befitted a linear regression equation with weak positive correlation (Pearson correlation coefficient ¼ 0.08). The relapse rates in follow up categories of <5 years (26.6 ± 15.6%), 5-7 years (30.8 ± 16.3%) and >7 years (28.4 ± 6.2%) were similar statistically (Analysis of variance, ANOVA). Conclusions: Approximately 1 in 3 clubfoot patients suffer relapse post Ponseti technique and standard bracing protocol. A weak positive correlation was observed for relapses when correlated with increasing follow up years. The relapses however tend to slow down after initial growth years. There is a need to educate the care receivers regarding the possibility of late relapses despite proper Ponseti treatment and accordingly to keep them under supervised follow up for longer periods.

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Reoccurrence rate in Ponseti treated clubfeet: A meta-regression

Cited by 8 publications

References 18 publications

Prospective, Randomized Ponseti Treatment for Clubfoot: Orthopaedic Surgeons Versus Physical Therapists

Prospective, Randomized Ponseti Treatment for Clubfoot: Orthopaedic Surgeons Versus Physical Therapists

Prognostic factors for recurrent idiopathic clubfoot deformity: a systematic literature review and meta-analysis

Relapses in clubfoot treated with Ponseti technique and standard bracing protocol- a systematic analysis

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