Relapses in clubfoot treated with Ponseti technique and standard bracing protocol- a systematic analysis

Area of Science:

• Orthopedics
• Pediatric Orthopedics
• Sports Medicine

Background:

• Clubfoot, or congenital talipes equinovarus, is a common congenital foot deformity.
• The Ponseti technique, combined with standard bracing, is a widely adopted treatment for idiopathic clubfoot.
• Understanding relapse patterns is crucial for optimizing long-term outcomes.

Purpose of the Study:

• To determine relapse rates in children with clubfoot treated with the Ponseti technique and standard bracing.
• To analyze the correlation between relapse occurrence and the duration of patient follow-up.
• To evaluate the effectiveness of 5 and 7-year timelines for relapse cessation.

Main Methods:

• A systematic literature search was conducted on PubMed for studies from January 2001 to November 2020.
• Included studies focused on idiopathic clubfoot treated with the Ponseti technique and a defined bracing protocol with a minimum 4-year follow-up.
• Data on patient numbers, follow-up duration, and relapse percentages were extracted and analyzed.

Main Results:

• The pooled analysis included 2206 patients from 24 studies, with an average follow-up of 6 years.
• The overall average relapse rate was 30%, with similar rates across follow-up categories (<5, 5-7, and >7 years).
• A weak positive correlation was found between longer follow-up duration and increased relapse rates.

Conclusions:

• Relapse affects approximately one in three children treated for clubfoot with the Ponseti method and bracing.
• While relapses correlate weakly with longer follow-up, they tend to decrease after the initial growth phase.
• Long-term supervised follow-up is recommended to manage potential late relapses, and patient education is essential.