Pressure sores and bracing complications in idiopathic clubfoot

Idiopathic congenital talipes equinovarus (CTEV) is commonly treated with the Ponseti method, including foot abduction boots and bar (FABB) bracing to maintain correction. Complications such as pressure sores may disrupt bracing and increase recurrence risk, yet published data on brace-related complications are limited.

To determine the frequency, type, and timing of FABB-related complications in idiopathic clubfoot and compare pressure sore rates between Markell and Mitchell FABB.

A retrospective review was conducted of 247 children (374 feet) with idiopathic CTEV treated at a tertiary pediatric hospital in Australia (2010-2021).

All patients underwent Ponseti casting, Achilles tenotomy when indicated, and were fitted with Markell boots with Denis-Browne bar FABB (2010-2018) or Mitchell boots with Ponseti bar FABB (2018-2021). Primary outcomes were FABB-related complications, including pressure sores requiring temporary brace cessation. Risk difference and relative risk (RR) were calculated between FABB types.

Forty-three children (17.4%) developed pressure sores requiring brace cessation. Incidence was higher with Mitchell FABB (22.9%) compared with Markell (12.6%), with RR 1.82 (95% confidence interval [CI] 1.03-3.20) and risk difference 0.103 (95% CI 0.007-0.200). Other complications included noncompliance (33.2%), heel lifting (25.1%), and recasting (31.2%). Median age of pressure sore onset was 4.8 months.

Brace-related complications were common, and pressure sores were nearly twice as frequent in Mitchell FABB era compared with Markell FABB era. These findings highlight the importance of close surveillance, caregiver education, and brace modification strategies to optimize tolerance and maintain compliance during bracing phase of Ponseti treatment.