Serial Casting Before Relapse Surgery: Investigating the Challenges of Relapsed Clubfoot Care

Area of Science:

• Pediatric Orthopedics
• Congenital Limb Deformities

Background:

• Clubfoot is a common congenital condition treated with the Ponseti method.
• Relapse occurs in up to 40% of cases, often necessitating surgery.
• The role of presurgical casting before relapse management is not well-defined.

Purpose of the Study:

• To evaluate if presurgical casting reduces the number and complexity of surgeries for relapsed clubfoot in children under 16.
• To compare surgical outcomes between children with relapsed clubfoot who received presurgical casting and those who did not.

Main Methods:

• Retrospective cohort audit of children surgically treated for relapsed clubfoot (2015-2024) after initial Ponseti management.
• Participants were divided into groups based on receiving presurgical casting or not.
• Primary outcomes were the number and complexity of surgical procedures.

Main Results:

• The presurgical casting group showed a 40.0% reduction in surgical complexity versus 1.9% in the noncasting group (P=0.001).
• High-complexity surgeries were less frequent in the casting group (53.3%) compared to the noncasting group (80.6%) (P=0.004).
• Noncompliance with orthosis use was noted, and Indigenous children were overrepresented in the relapse cohort.

Conclusions:

• Presurgical casting may decrease the surgical burden for relapsed clubfoot.
• This evidence can inform clubfoot service development and treatment strategies for relapsed cases.