Factors affecting outcome after the use of the Ponseti method for the management of idiopathic clubfoot, a retrospective study in an orthopaedic referral institute

In the last few decades Ponseti method has replaced soft tissue releases as the gold standard in the management of idiopathic clubfoot. However, the recurrence of the deformity is common without post tenotomy bracing. The purpose of this study was to retrospectively see various attributes of the patients associated with poor outcome after use of Ponseti method in idiopathic clubfoot management. Seventy nine consecutive patients with one hundred and twenty three idiopathic clubfeet treated with Ponseti method by single orthopaedic surgeon were followed for a period of two years and recurrence of the deformity was studied in relation to age of patient at presentation (< 3 months or more), sex of the patient, severity of the deformity (moderate to severe verses (Vs.) very severe), compliance to post tenotomy bracing (compliant Vs. non compliant), educational level of parents (high school or less) and access of parents to internet (Yes or No) and odds ratio for recurrence and level of significance determined for each using Fisher's exact t-test. Non compliance in seventeen patients (17.7 %) with post tenotomy bracing was the most important factor related to the recurrence, with an odds ratio of 6.22 (P =0.0059). Educational level (less than high school) of parents (36.7%) was the second most important factor with odds ratio of 5.5 (P=0.0073). Fifteen patients with severe Demiglio scoring feet had an odds ratio of 5.3 (P= 0.0097) for the recurrence of the deformity. Inaccess of the parents to the internet had an odds ratio of 6.33 (P =0.011) for the recurrence of the deformity. Age and sex of the patients was not found to have a significant effect on the recurrence of the deformity. In conclusion, the risk factors associated with recurrence of the idiopathic clubfoot deformity except severity of the deformity are modifiable and extra minutes can be spent with risk group parents during follow up visits to prevent a recurrence by making them understand natural history of the corrected foot without post tenotomy bracing, encouraging them for regular follow up visits, arranging interactive sessions with other patients who are regular in their follow up and compliant with bracing, and encouraging the literate parents to update their information about clubfoot from internet.