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Predicting the need for surgical intervention in patients with idiopathic clubfoot
Rachel Y Goldstein1, Derek A Seehausen, Alice Chu
1*Boston Children's Hospital, Boston, MA †Children's Hospital Los Angeles, Los Angeles, CA ‡NYU Hospital for Joint Diseases, New York, NY.
Insights
Noncompliance with foot abduction orthosis (FAO) and higher initial severity scores significantly increase the risk of surgery for idiopathic clubfoot. Female patients also face a higher likelihood of needing surgical intervention.
Area of Science:
- Orthopedics
- Pediatric Orthopedics
- Clubfoot Treatment
Background:
- Idiopathic clubfoot requires effective treatment to prevent long-term complications.
- The Ponseti method is a standard non-surgical approach for idiopathic clubfoot.
- Predicting the need for surgical intervention early is crucial for patient management.
Purpose of the Study:
- To identify early predictive factors for surgical intervention in idiopathic clubfoot patients treated with the Ponseti method.
- To assess the impact of compliance with the foot abduction orthosis (FAO) on surgical outcomes.
- To correlate initial disease severity scores with the need for surgery.
Main Methods:
- Retrospective evaluation of 86 patients (134 feet) with idiopathic clubfoot treated using the Ponseti method.
- Data collected included age at presentation, treatment history, cast numbers, percutaneous Achilles tenotomy (PAT) need, FAO initiation and compliance, and additional casting.
- Dimeglio/Bensahel and Catterall/Piriani scores were assessed at multiple time points.
Main Results:
- 32% of feet required surgery beyond percutaneous Achilles tenotomy (PAT).
- Noncompliance with the foot abduction orthosis (FAO) increased surgical risk by 7.9 times (P<0.001).
- Female sex (OR 5.4, P=0.003) and higher initial Dimeglio/Bensahel scores (OR 1.3-1.5, P<0.05) were associated with increased surgical need.
Conclusions:
- Early identification of risk factors can guide treatment intensity for idiopathic clubfoot.
- Female gender and higher initial severity scores predict increased need for surgery.
- Noncompliance with the foot abduction orthosis (FAO) represents the most significant risk factor for surgical intervention.
Background:
The purpose of this study was to determine the early factors associated with the need for surgical interventions in patients with idiopathic clubfoot treated with the Ponseti method.
Methods:
All patients with idiopathic clubfoot treated with Ponseti method at our institution with >3 years of follow-up were evaluated. Age at presentation, history of previous treatment, number of casts used, need for percutaneous Achilles tenotomy (PAT), age of initiation of foot abduction orthosis (FAO), compliance with FAO, and need for additional casts were recorded. Dimeglio/Bensahel and Catterall/Piriani scores were recorded at initial presentation, at initiation of FAO, at 1, 2, 3 years of follow-up, and at the most recent follow-up.
Results:
Since 2000, 86 patients (134 feet) had >3 years of follow-up from time of initial presentation, and 43 of these feet (32%) had undergone surgery beyond a PAT. Patients who were noncompliant with the FAO were 7.9 times more likely to need surgery than those who were compliant [confidence interval (CI), 2.8-22.0; P<0.001]. Female patients were 5.4 times more likely to need surgery than male patients (CI, 1.8-16.6; P=0.003). For every 1 point increase in Dimeglio/Bensahel score at presentation, patients were 1.3 times more likely to need surgery (CI, 1.0-1.5; P=0.033). For every 1 point increase in Dimeglio/Bensahel score at initiation of the FAO, patients were 1.5 times more likely to need surgery (1.1-2.0, P=0.005). Moreover, for each additional cast required before the initiation of the FAO, patients were 1.5 times less likely to need surgery (CI, 1.1-2.7; P=0.030). No other variable significantly contributed to predicting the need for surgery.
Conclusions:
There are early factors that can be used to predict increased risk for surgical intervention in patients undergoing treatment for idiopathic clubfoot. Female patients and those patients with higher Dimeglio/Bensahel scores at presentation and at initiation of the FAO are at increased risk for needing surgical intervention. Noncompliance with the FAO is associated with the highest risk for surgical intervention.
Level Of Evidence:
Level III.
