Dr Océane Mauffrey,
Department of Orthopaedics, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, United States of America,
E-mail: oceane_mauffrey@med.unc.edu
Objective: The Ponseti method is a widely adopted nonsurgical approach for correcting clubfoot deformities, but its success relies heavily on consistent brace usage during the maintenance phase. The present study seeks to analyze whether socioeconomic factors affect brace adherence in clubfoot patients.
Study Design: The present study was reviewed and approved by the Institutional Review Board. The charts of 83 patients treated for clubfoot by two providers at a single institution between 2013 and 2022 were reviewed to investigate the impact of various socioeconomic variables on brace adherence and its association with treatment outcomes. Brace adherence was determined based on provider documentation noting self-reported parental accounts of adherence. Annual family income was derived from North Carolina census data based on zip code. Chi-squared tests and two sample t-tests analyses were performed, controlling for clinical factors such as treatment strategy, comorbidities, laterality, and prenatal diagnosis.
Results: Patients from families with higher annual income based on zip codes demonstrated higher brace adherence rates. Patients from racial minority backgrounds exhibited reduced adherence with brace usage, likely in the context of greater obstacles to care. No significant correlations were found between brace adherence and distance to the hospital, gender, or language.
Conclusion: The findings highlight the multifaceted nature of brace adherence in clubfoot patients undergoing Ponseti treatment, suggesting the importance of addressing specific patient demographics, socioeconomic contexts, and caregiver support structures to optimize treatment outcomes. Further research involving a larger and more diverse cohort is necessary to validate these findings.
Keywords: Clubfoot, Social determinants of health, Clinical outcomes, Brace compliance.
References
- 1. Bozkurt C, Sarıkaya B, Sipahioğlu S, Altay MA, Çetin BV. Using the modified ponseti method to treat complex clubfoot: Early results. Jt Dis Relat Surg 2021;32:170-6. [Google Scholar]
- 2. Ganesan B, Luximon A, Al-Jumaily A, Balasankar SK, Naik GR. Ponseti method in the management of clubfoot under 2 years of age: A systematic review. PLoS One 2017;12:0178299. [Google Scholar]
- 3. Hordyjewska-Kowalczyk E, Nowosad K, Jamsheer A, Tylzanowski P. Genotype-phenotype correlation in clubfoot (talipes equinovarus). J Med Genet 2022;59:209-19. [Google Scholar]
- 4. Bonilla-Musoles F, Machado LE, Osborne NG. Multiple congenital contractures (Congenital multiple arthrogryposis). J Perinat Med 2002;30:99-104. [Google Scholar]
- 5. Esparza M, Tran E, Richards BS, Jo CH, Shivers C, Karacz C, et al. The ponseti method for the treatment of clubfeet associated with amniotic band syndrome: A single institution 20-year experience. J Pediatr Orthop 2021;41:301-5. [Google Scholar]
- 6. Stoll C, Alembick Y, Dott B, Roth MP. Associated anomalies in cases with congenital clubfoot. Am J Med Genet A 2020;182:2027-36. [Google Scholar]
- 7. Rastogi A, Agarwal A. Long-term outcomes of the Ponseti method for treatment of clubfoot: A systematic review. Int Orthop 2021;45:2599-608. [Google Scholar]
- 8. Al-Mohrej OA, Alshaalan FN, Alhussainan TS. Is the modified ponseti method effective in treating atypical and complex clubfoot? A systematic review. Int Orthop 2021;45:2589-97. [Google Scholar]
- 9. Zionts LE, Dietz FR. Bracing following correction of idiopathic clubfoot using the ponseti method. J Am Acad Orthop Surg 2010;18:486-93. [Google Scholar]
- 10. Johnson RR, Friedman JM, Becker AM, Spiegel DA. The ponseti method for clubfoot treatment in low and middle-income countries: A systematic review of barriers and solutions to service delivery. J Pediatr Orthop 2017;37:e134-9. [Google Scholar]
- 11. De La Taille E, Sales De Gauzy J, Gaubert Noirot M. Idiopathic clubfoot treatment and heterogeneity of current therapeutic strategies: The ponseti method versus the French functional method (a systematic review). Arch Pédiatrie 2021;28:422-8. [Google Scholar]
- 12. Chu A, Lehman WB. Persistent clubfoot deformity following treatment by the ponseti method. J Pediatr Orthop B 2012;21:40-6. [Google Scholar]
- 13. Hosseinzadeh P, Kelly DM, Zionts LE. Management of the relapsed clubfoot following treatment using the ponseti method. J Am Acad Orthop Surg 2017;25:195-203. [Google Scholar]
- 14. North Carolina Department of Commerce. 2024 North Carolina Development Tier Designations. North Carolina: North Carolina Department of Commerce; 2023. [Google Scholar]
- 15. Wang YY, Su YC, Tu YK, Fang CJ, Hong CK, Huang MT, et al. Determining the optimal treatment for idiopathic clubfoot: A network meta-analysis of randomized controlled trials. J Bone Jt Surg Am 2024;106:356-67. [Google Scholar]
- 16. Bina S, Pacey V, Barnes EH, Burns J, Gray K. Interventions for congenital talipes equinovarus (clubfoot). Cochrane Database Syst Rev 2020;2020:CD008602. [Google Scholar]
- 17. Recordon JA, Halanski MA, Boocock MG, McNair PJ, Stott NS, Crawford HA. A prospective, median 15-year comparison of ponseti casting and surgical treatment of clubfoot. J Bone Jt Surg Am 2021;103:1986-95. [Google Scholar]
- 18. Švehlík M, Floh U, Steinwender G, Sperl M, Novak M, Kraus T. Ponseti method is superior to surgical treatment in clubfoot – long-term, randomized, prospective trial. Gait Posture 2017;58:346-51. [Google Scholar]
- 19. Zhao D, Li H, Zhao L, Liu J, Wu Z, Jin F. Results of clubfoot management using the ponseti method: Do the details matter? A systematic review. Clin Orthop Relat Res 2014;472:1329-36. [Google Scholar]
- 20. Dreise M, Elkins C, Muhumuza MF, Musoke H, Smythe T. Exploring bracing adherence in ponseti treatment of clubfoot: A comparative study of factors and outcomes in Uganda. Int J Environ Res Public Health 2023;20:6396. [Google Scholar]
- 21. Hegazy M, El Barbary H, Hammoud M, Arafa A, Mohamed MT, Barakat AS, et al. The foot external rotation above-knee (FERAK) brace versus the Denis Browne brace for management of idiopathic clubfoot following ponseti casting: A randomized controlled trial. Int Orthop 2022;46:313-9. [Google Scholar]
- 22. Haft GF, Walker CG, Crawford HA. Early clubfoot recurrence after use of the ponseti method in a New Zealand population. J Bone Jt Surg Am 2007;89:487-93. [Google Scholar]
- 23. Walter C, Sachsenmaier S, Wünschel M, Teufel M, Götze M. Clubfoot treatment with ponseti method–parental distress during plaster casting. J Orthop Surg Res 2020;15:271. [Google Scholar]
- 24. Tonkovich N, Baskar D, Frick S. parental concerns regarding bracing compliance for children with clubfoot: Seeking support on Facebook. Cureus 2023;15:e43761. [Google Scholar]
- 25. Besselaar AT, Melis L, Van Der Steen MC. Quality of life of clubfoot patients during the brace period of the ponseti method. Foot (Edinb) 2022;52:101895. [Google Scholar]
- 26. Halanski MA, Huang JC, Walsh SJ, Crawford HA. Resource utilization in clubfoot management. Clin Orthop Relat Res 2009;467:1171-9. [Google Scholar]
- 27. Hussain H, Burfat AM, Samad L, Jawed F, Chinoy MA, Khan MA. Cost‐effectiveness of the ponseti method for treatment of clubfoot in Pakistan. World J Surg 2014;38:2217-22. [Google Scholar]
- 28. Drew S, Gooberman-Hill R, Lavy C. What factors impact on the implementation of clubfoot treatment services in low and middle-income countries?: A narrative synthesis of existing qualitative studies. BMC Musculoskelet Disord 2018;19:72. [Google Scholar]
- 29. Cady R, Hennessey TA, Schwend RM. Diagnosis and treatment of idiopathic congenital clubfoot. Pediatrics 2022;149:e2021055555. [Google Scholar]