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Bracing for Impact: A Survey Analysis of the Impact of Socioeconomic Factors on Brace Adherence in Clubfoot

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Journal of Clinical Orthopaedics | Vol 10 | Issue 1 | January-June 2025 | page: 4-7 | Océane Mauffrey, Kevin Yu, Malvika Choudhari, Ashley Lynn Habig, Alec Pugh, Vinay Narotam

DOI: https://doi.org/10.13107/jcorth.2025.v10i01.702

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2025; The Author(s).

Submitted Date: 11 Jan 2025, Review Date: 08 Mar 2025, Accepted Date: 10 Apr 2025 & Published Date: 30 Jun 2025

Author: Océane Mauffrey [1], Kevin Yu [2], Malvika Choudhari [1], Ashley Lynn Habig [3], Alec Pugh [1], Vinay Narotam [4]

[1] The University of North Carolina, School of Medicine, 321 S. Columbia Street, Chapel Hill, NC 27599, United States of America
[2] The University of North Carolina, Gillings School of Public Health 135 Dauer Drive, Chapel Hill, NC, 27599, United States of America
[3] The University of North Carolina, Undergraduate, Chapel Hill, NC, 27599, United State of America
[4] The University of North Carolina, Department of Orthopaedics, 130 Mason Farm Road, Chapel Hill, NC 27514, United States of America Address of Correspondence

Address of Correspondence

Dr. Océane Mauffrey,
The University of North Carolina, School of Medicine, 321 S. Columbia Street, Chapel Hill, NC 27599, United States of America
E-mail: Oceane_mauffrey@med.unc.edu

Abstract

Background: Clubfoot is a congenital deformity characterized by cavus deformity of the midfoot, adductus of the forefoot and equinus and varus of the hindfoot. The Ponseti method, a series of casting and bracing protocols has become the standard of care as a highly effective non-surgical intervention. Poor adherence with stringent brace wearing protocols has been identified as one of the leading causes of deformity recurrence with the Ponseti method. The present study seeks to uncover the socioeconomic variables which may contribute to brace adherence.
Methods: This survey study included 219 patients, 56 responded (25.5% RR). The survey assessed zip code, annual income, number of caregivers and siblings, brace adherence, and recurrence. Adherence was measured categorically (Likert) and continuously (0-100%); recurrence was measured categorically (yes/no). A t-test was used to evaluate the relationship between adherence and deformity recurrence. All other variables were analyzed using chi squared and Fischer’s exact.
Results: 23 patients reported an annual income of $100,000 or greater (n=23), and most had received at least a college education (n=37), many had graduate’s degrees (n=20), most reported two caregivers (n=44), and 1 sibling (n=21). 36 patients reported brace wearing All of the time, and 21 patients reported their child needing to repeat serial casting or additional surgery, indicating recurrence. No significant relationship was found between brace adherence and deformity recurrence (p>0.05). No significant relationship was found between annual income, number of caregivers, highest level of education, number of siblings against brace adherence (p>0.05).
Conclusion: These findings contrast with the well-documented risk of recurrence with decreased brace adherence; perhaps due to parental overreporting of brace wearing. The expected relationship between social variables and brace adherence was also not supported potentially because of a skew in our population towards patients with higher education and income.
Keywords: Clubfoot, Social Determinants of Health, Clinical Outcomes, Brace Compliance

References

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6. Wang YY, Su YC, Tu YK, et al. Determining the Optimal Treatment for Idiopathic Clubfoot: A Network Meta-Analysis of Randomized Controlled Trials. J Bone Jt Surg. 2024;106(4):356-367. doi:10.2106/JBJS.22.01210
7. Recordon JAF, 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. 2021;103(21):1986-1995. doi:10.2106/JBJS.20.02014
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How to Cite this article: Mauffrey O, Yu K, Choudhari M, Habig AL, Pugh A, Narotam V. Bracing for Impact: A Survey Analysis of the Impact of Socioeconomic Factors on Brace Adherence in Clubfoo. Journal of Clinical Orthopaedics January-June 2025;10(1):4-7.

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A Retrospective Review Assessing the Impact of Socioeconomic Factors on Brace Adherence in Clubfoot Patients Treated with the Ponseti Method

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Journal of Clinical Orthopaedics | Vol 10 | Issue 1 | January-June 2025 | page: 38-44 | B S Océane Mauffrey, B A Kevin Yu, B S Malvika Choudhari, Ashley Lynn Habig, Vinay Narotam

DOI: https://doi.org/10.13107/jcorth.2025.v10i01.712

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2025; The Author(s).

Submitted Date: 14 Feb 2025, Review Date: 15 Mar 2025, Accepted Date: 28 Apr 2025 & Published Date: 30 Jun 2025

Author: B S Océane Mauffrey [1], B A Kevin Yu [2], B S Malvika Choudhari [1], Ashley Lynn Habig [3], Vinay Narotam [4]

[1] Department of Orthopaedics, University of North Carolina, School of Medicine, Chapel Hill, North Carolina, United States of America,
[2] Department of Orthopaedics, University of North Carolina, Gillings School of Public Health, Chapel Hill, North Carolina, United States of America,
[3] Department of Orthopaedics, University of North Carolina, Undergraduate, Chapel Hill, North Carolina, United States of America,
[4] Department of Orthopaedics, University of North Carolina, Chapel Hill, North Carolina, United States of America

Address of Correspondence

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

Abstract

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

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  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.
  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.
  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.
  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.
  9. Zionts LE, Dietz FR. Bracing following correction of idiopathic clubfoot using the ponseti method. J Am Acad Orthop Surg 2010;18:486-93.
  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.
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  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.
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How to Cite this article: Mauffrey BSO, Yu BAK, Choudhari BSM, Habig AL, Narotam V. A Retrospective Review Assessing the Impact of Socioeconomic Factors on Brace Adherence in Clubfoot Patients Treated with the Ponseti Method. Journal of Clinical Orthopaedics January-June 2025;10(1):38-44.

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Evolution of Femoral Neck Implants: In Search of the Perfect Implant

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Journal of Clinical Orthopaedics | Vol 9 | Issue 2 |  July-December 2024 | page: 01-05 | Sachin Kale, Arvind Vatkar, Sanjay Dhar, Pramod Bhor, Ashish Phadnis, Rohan Jayaram

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.640

Open Access License: CC BY-NC 4.0

Copyright Statement: Copyright © 2024; The Author(s).

Submitted Date: 11 Jul 2024, Review Date: 08 Aug 2024, Accepted Date: 12 Sep 2024 & Published Date: 10 Dec 2024

Author: Sachin Kale [1], Arvind Vatkar [2, 3], Sanjay Dhar [1], Pramod Bhor [2], Ashish Phadnis [4], Rohan Jayaram [1]

[1] Department of Orthopaedics, D.Y Patil School of Medicine and Hospital, Navi Mumbai, Maharashtra, India,
[2] Department of Orthopaedics, Fortis Hiranandani Hospital, Navi Mumbai, Maharashtra, India,
[3] Department of Orthopaedics, MGM Medical College, Navi Mumbai, Maharashtra, India
[4] Department of Orthopaedics, Jupiter Hospital, Thane, Maharashtra, India

Address of Correspondence

Dr. Sachin Kale
Professor and Head of Unit, Department of Orthopaedics, D.Y Patil School of Medicine and Hospital, Navi Mumbai, Maharashtra, India.
Email: sachinkale@gmail.com

Abstract

Femoral neck fractures have significant orthopedic difficulty, particularly in younger patients with high-energy trauma. The femoral neck system improves rotational stability, allows for controlled dynamic compression, and is less invasive than cannulated cancellous screws. However, steep learning curves, more significant starting expenditures, and more long-term data still need to be addressed. Emerging technologies, such as robotic-assisted surgeries and personalized implants created with artificial intelligence and 3D printing, can transform fracture therapy by boosting accuracy, lowering complications, and improving patient-specific care. Future advances will improve results and patient happiness.
Keywords: Femoral neck fractures, femoral neck system, cannulated screws, rotational stability, angular stability, minimally invasive surgery, fracture fixation, osteoporotic fractures, clinical outcomes, implant innovations.

How to Cite this article: Kale S, Vatkar A, Dhar S, Bhor P, Phadnis A, Jayaram R. Evolution of Femoral Neck Implants: In Search of the Perfect Implant. Journal of Clinical Orthopaedics July-December 2024;9(2):01-05.

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