Related Experiment Video
Updated: May 15, 2025
Author Spotlight: Repetitive Transcranial Magnetic Stimulation Combined with Movement Observation in Cerebral Palsy
Published on: August 9, 2024
Correlation Between Socioeconomic Status and Brace Compliance in Idiopathic Clubfoot Deformities
Ennio Rizzo Esposito1, Rachel Phillips1, Emily V Leary1
1Orthopedic Surgery, University of Missouri, Columbia, USA.
Insights
Socioeconomic factors did not impact clubfoot (congenital talipes equinovarus) bracing compliance. However, missed appointments and non-compliance significantly increased deformity recurrence risk.
Area of Science:
- Pediatric Orthopedics
- Clinical Research
- Public Health
Background:
- Congenital talipes equinovarus (clubfoot) is a common birth deformity.
- The Ponseti technique, involving casting, tenotomy, and bracing, is the standard treatment.
- Understanding factors influencing treatment adherence is crucial for optimal outcomes.
Purpose of the Study:
- To investigate the association between socioeconomic factors and adherence to clubfoot bracing.
- To identify predictors of bracing compliance and deformity recurrence in infants treated with the Ponseti method.
Main Methods:
- Retrospective chart review of 43 infants with idiopathic clubfoot treated between 2018-2021.
- Compliance defined by adherence to appointments, reported brace wear, and absence of non-compliance notes.
- Recurrence assessed at minimum one-year follow-up for relapse or need for further intervention.
Main Results:
- No correlation found between socioeconomic factors (income, education, insurance) and bracing compliance.
- Missed clinic appointments significantly increased the odds of noncompliance (OR=7.0, P=0.01).
- Brace non-compliance was strongly associated with deformity recurrence (OR=74.8, P<0.001).
Conclusions:
- Socioeconomic status does not appear to influence clubfoot bracing adherence.
- Consistent attendance at clinic appointments is vital for successful treatment.
- Strict adherence to bracing is critical to prevent clubfoot recurrence.
Background:
Congenital talipes equinovarus (CTEV), or clubfoot, is one of the most common foot deformities seen at birth. The Ponseti technique is the most common method to treat clubfoot and consists of gentle manipulation with serial casting, a percutaneous Achilles tendon tenotomy, and bracing for the first few years of life. The purpose of this study was to determine whether socioeconomic factors influence compliance with clubfoot bracing for families with infants who have idiopathic clubfoot treated by the Ponseti method.
Methodology:
All patients with clubfoot deformity who began primary treatment at our pediatric orthopedic clinic between February 2018 and May 2021 were included in a retrospective chart review. Compliance was defined as strict adherence to the initial casting and tenotomy appointments, in addition to the caregiver's reported compliance with brace wear, and no mention of non-compliance in the patient's medical record. Recurrence was defined as relapse of the deformity after at least one year of follow-up and/or the need for additional casting or tenotomy.
Results:
Forty-three patients were included in the final analysis of compliance with bracing. No significant correlations were seen between the rate of compliance with bracing and any of the socioeconomic factors assessed in this study. The odds of noncompliance were 7.0 times higher in patients who had one or more missed clinic appointments, compared to those who attended all appointments (P = 0.01). Forty-one patients were analyzed at a minimum one-year follow-up for recurrence of deformity. The odds ratio for recurrence of deformity in patients who were noncompliant with bracing was 74.8 compared to those who were compliant (P =< 0.001).
Conclusions:
Socioeconomic factors, including household income, education level, zip code, employment status of caregivers, and insurance status, were not associated with bracing compliance or recurrence of the clubfoot deformity. This was a level 2 observational study.
Related Concept Videos
01:12General Case of Eccentric Axial Loading
Consider a member subjected to equal and opposite forces that are applied along a line that does not coincide with the member's neutral axis. In unsymmetrical...
01:10Ankle Joint
01:09Functional Classification of Joints
The functional classification of joints is determined by the amount of mobility between the adjacent bones. Joints are functionally classified as a synarthrosis or immobile joint, an amphiarthrosis or slightly moveable joint, or as a diarthrosis, a freely moveable joint. Fibrous and cartilaginous joints can be functionally classified as either synarthroses or amphiarthroses, whereas all synovial joints are classified as diarthroses.
Synarthrosis
An...
01:09Changes in the Appendicular Skeleton with Age
Initially, the limb buds consist of a core of mesenchyme covered by a layer of ectoderm. The ectoderm at the end of the limb bud thickens to form a narrow crest called the apical ectodermal ridge. This ridge stimulates the underlying...
01:20Structural Classification of Joints
A fibrous joint is where the adjacent bones are united by fibrous connective...
01:30Assessment of Airway, Skin Color, and Use of Accessory Muscles
Introduction
The initial evaluation of a patient's respiratory system...