September 2011

Orthotic clubfoot outcomes depend on complexity, not socioeconomics

In the moment: O&P

The critical factor affecting compliance with the orthotic aspect of Ponseti clubfoot therapy—and its success—appears to be complexity of the therapy, not parents’ education and income levels, according to research published in the September issue of the Journal of Pediatric Orthopaedics.

Achieving good outcomes with Ponseti casting for clubfeet requires several years of intensive post-treatment orthotic management. A group of investigators in the pediatric orthopedic departments at two Puerto Rican hospitals, motivated by suggestions that the poor compliance common with this modality may be related to parents’ socioeconomic status, undertook their own investigation of variables relating to postcasting orthotic compliance.

Investigators followed 53 patients with 73 idiopathic club­feet for 48 months after children completed the casting component of Ponseti correction. Noncompliance with orthotic devices was significantly correlated with recurrence, which occurred in 24 feet.

The noncompliance rate did not show any correlation with the patient demographic data or parent’s education level, insurance, or cultural factors. Authors concluded that clinicians should consider less demanding postcasting protocols to improve compliance and outcomes.

By Emily Delzell

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