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Clubfoot treatment with Ponseti method-parental distress during plaster casting
Christian Walter1, Saskia Sachsenmaier2, Markus Wünschel3
1Orthopedic Department, University Hospital Tübingen, Hoppe Seyler-Str. 3, 72076, Tübingen, Germany. Christian.Walter@med.uni-tuebingen.de.
Insights
Parental distress regarding clubfoot treatment significantly decreases during serial plaster casting, with children's future mobility being a primary concern. Educating parents on long-term outcomes is crucial for managing their worries.
Area of Science:
- Pediatrics
- Orthopedics
- Developmental Psychology
Background:
- Clubfoot is a common congenital musculoskeletal defect.
- The Ponseti method, involving serial plaster casting and Achilles tenotomy, is the gold standard treatment.
- Parental distress during clubfoot treatment, particularly during casting, is largely unexamined.
Purpose of the Study:
- To assess parental distress before and during clubfoot treatment.
- To investigate the correlation between deformity severity (Pirani score) and parental distress.
- To evaluate changes in parental mental resilience throughout the casting process.
Main Methods:
- A questionnaire assessing physical capacity, mental resilience, and child/parent scores was developed.
- Twenty parents of children with clubfoot were interviewed.
- Infant Pirani scores were recorded at the beginning (T0) and end (TE) of plaster casting.
Main Results:
- Parents reported high levels of concern regarding their child's physical capacity and motion.
- Parental mental resilience significantly improved during plaster casting (p = 0.015).
- The initial hypothesis of a correlation between Pirani score and parental distress was rejected (Spearman's rho = 0.21).
Conclusions:
- Parental worries are primarily focused on the child's future mobility and social interaction.
- Parental distress is not directly correlated with the initial severity of the clubfoot deformity.
- Educational interventions highlighting excellent long-term functional outcomes are essential for parental support.
Background:
Clubfoot is one of the most prevalent musculoskeletal congenital defects. Gold standard treatment of idiopathic clubfoot is the conservative Ponseti method, including the reduction of deformity with weekly serial plaster casting and percutaneous Achilles tenotomy. It is well known that parents of children with severe and chronic illnesses are mentally stressed, but in recent studies regarding clubfoot treatment, parents were only asked about their satisfaction with the treatment. Largely unknown is parental distress before and during plaster casting in clubfoot. Therefore, we want to determinate first, how pronounced the parents' worries are before treatment and if they decrease during the therapy. Second, we hypothesized that parents faced with an extreme deformity (high Pirani score), reveal more distress, than parents whose children have a less pronounced deformity (low Pirani score). Therefore, we wanted to investigate whether the Pirani score correlates with the parents' mental resilience in relation to the therapy of the child as a global distress parameter.
Methods:
To answer this question, we developed a questionnaire with the following emphases: Physical capacity, mental resilience, motion score, parents score, and child score with point scores 1 (not affected) to 6 (high affected). Subsequently, we interviewed 20 parents whose children were treated with clubfeet and determined the Pirani score of the infants at the beginning (T0) and at the end (TE) of the treatment with plaster casting.
Results:
High values were obtained in child score (Mean (M) = 3.11), motion score (M = 2.63), and mental resilience (M = 2.25). During treatment, mental resilience improved (p = 0.015) significantly. Spearman correlation coefficient between Pirani score (T0) and mental resilience (T0) is 0.21, so the initial hypothesis had to be rejected.
Conclusion:
The issues of the children are in the focus of parental worries concerning clubfoot treatment, especially the assumed future motion and the assumed ability to play with other children. Particular emphasis should be placed on educating parents about the excellent long-term results in the function of the treated feet especially as this topic shows the greatest parental distress.
