Determining the Optimal Treatment for Idiopathic Clubfoot: A Network Meta-Analysis of Randomized Controlled Trials

Area of Science:

• Orthopedics
• Pediatric Surgery
• Biomechanical Engineering

Background:

• Clubfoot (congenital talipes equinovarus) is a common infant foot anomaly.
• Clinical consensus on optimal interventions, particularly those based on the Ponseti method, is lacking.
• This study systematically evaluates various treatments for idiopathic clubfoot.

Purpose of the Study:

• To compare the clinical outcomes of different interventions for treating idiopathic clubfoot.
• To identify the most effective treatment strategies based on current evidence.
• To inform clinical decision-making for clubfoot management.

Main Methods:

• A systematic literature search was performed across major databases (CENTRAL, MEDLINE, Embase, Scopus, CINAHL).
• Included were randomized controlled trials comparing interventions like the Ponseti method, accelerated Ponseti, Ponseti with Botox, Ponseti with TATT, Kite method, and surgery.
• Network meta-analyses (NMAs) were conducted following PRISMA guidelines, focusing on Pirani score changes and ankle dorsiflexion.

Main Results:

• The Ponseti method demonstrated superior outcomes in Pirani score changes, ankle dorsiflexion, cast number, adverse events, and total complications.
• The accelerated Ponseti method showed advantages in reduced time in casts and lower tenotomy rates.
• Early tibialis anterior tendon transfer (TATT) was associated with the lowest relapse rate, while Ponseti with Botox injection minimized the need for additional major surgery.

Conclusions:

• The Ponseti method is generally the optimal treatment for idiopathic clubfoot, despite potential for longer casting times and higher rates of tenotomy, relapse, and revision surgery.
• Modified approaches offer specific advantages, such as reduced casting time or lower relapse rates.
• Individualized tailoring of clubfoot treatments is crucial for achieving the best patient outcomes.