Background: The nonoperative technique for the treatment of
idiopathic congenital talipes equinovarus (clubfoot) described by Ponseti is a
popular method, but it requires two to four years of orthotic management. The
purpose of this study was to examine the patient characteristics and
demographic factors related to the family that are predictive of recurrent
foot deformities in patients treated with this method.
Methods: The cases of fifty-one consecutive infants with eighty-six
idiopathic clubfeet treated with use of the Ponseti method were examined
retrospectively. The patient characteristics at the time of presentation, such
as the severity of the initial clubfoot deformity, previous treatment, and the
age at the initiation of treatment, were examined with use of univariate
logistic regression analysis modeling recurrence. Demographic data on the
family, including annual income, highest level of education attained by the
parents, and marital status, as well as parental reports of compliance with
the use of the prescribed orthosis, were studied in relation to the risk of
recurrence.
Results: The parents of twenty-one patients did not comply with the
use of orthotics. Noncompliance was the factor most related to the risk of
recurrence, with an odds ratio of 183 (p < 0.00001). Parental educational
level (high-school education or less) also was a significant risk factor for
recurrence (odds ratio = 10.7, p < 0.03). With the numbers available, no
significant relationship was found between gender, race, parental marital
status, source of medical insurance, or parental income and the risk of
recurrence of the clubfoot deformity. In addition, the severity of the
deformity, the age of the patient at the initiation of treatment, and previous
treatment were not found to have a significant effect on the risk of
recurrence.
Conclusion: Noncompliance 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. The
identification of patients who are at risk for recurrence may allow
intervention to improve the compliance of the parents with regard to the use
of orthotics, and, as a result, improve outcome.
Level of Evidence: Prognostic study, Level II-1
(retrospective study). See Instructions to Authors for a complete description
of levels of evidence.