Clubfoot relapse: does presentation differ based on age at initial relapse?

Area of Science:

• Orthopedics
• Pediatric Orthopedics
• Clubfoot Treatment

Background:

• The Ponseti method is standard for idiopathic clubfoot.
• Predicting relapse and optimal bracing duration remains challenging.
• Extended bracing may not be necessary for all patients.

Purpose of the Study:

• To compare bracing patterns and relapse timing in idiopathic clubfoot.
• To identify predictable patterns in clubfoot recurrence.
• To inform optimal bracing strategies post-Ponseti treatment.

Main Methods:

• Retrospective analysis of 70 patients with idiopathic clubfoot experiencing relapse after Ponseti treatment.
• Data collection on demographics, treatment adherence, and brace adherence.
• Comparison of patients relapsing before vs. after age two.

Main Results:

• 56% of patients relapsed before age two; 44% relapsed after age two.
• Patients relapsing before age two showed significantly lower brace adherence (28%) compared to those relapsing after age two (74%) (p < 0.001).
• Subsequent relapse occurred in 69% of patients with initial relapse before age two.

Conclusions:

• Early recurrence (before age two) of idiopathic clubfoot is associated with significantly higher rates of bracing non-adherence.
• Bracing adherence does not influence the likelihood of subsequent recurrence after an initial relapse before age two.
• Findings suggest a need to re-evaluate universal bracing recommendations up to age four.