Prognostic Factors for Relapse of Idiopathic Clubfoot: A Cohort Study

The aim of our observational study was to investigate if initial severity of deformity, residual deformity post-casting, and age of cessation of bracing were predictive of clubfoot relapse.

Children with idiopathic clubfoot, treated at our institution from 2014 to 2022, were recruited. Initial and post-casting Pirani scores and range of motion, and age of cessation of bracing were compared between relapse and no relapse groups. Logistic regression analyses were performed to identify predictive factors.

Of 93 clubfoot (in 62 children), 40 feet had at least one relapse before the age of five. The mean follow-up duration was 79.52 months. The relapse group had significantly higher initial Pirani scores-empty heel (p = 0.005), medial crease (p < 0.001), lateral head of talus (p = 0.015), and total Pirani score (p = 0.002). Initial medial crease score (p = 0.018) and post-casting empty heel score (p = 0.021) significantly predicted relapses. Study limitations are discussed in the full text.

Greater initial medial crease score and residual empty heel score were associated with higher relapse rates. Physiotherapy follow-up for at least five years is recommended. Findings may inform targeted follow-up strategies for high-risk children.