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 Pediatrics Test 3: Club Foot/Hip/Spine
CME 1: January, February, March 2004
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The Journal of Bone and Joint Surgery (American) 86:22-27 (2004)
© 2004 The Journal of Bone and Joint Surgery, Inc.

Factors Predictive of Outcome After Use of the Ponseti Method for the Treatment of Idiopathic Clubfeet

Matthew B. Dobbs, MD1, J.R. Rudzki, MD1, Derek B. Purcell, MD1, Tim Walton, RN, BSN1, Kristina R. Porter, RN, BSN2 and Christina A. Gurnett, MD, PhD1

1 Departments of Orthopaedic Surgery (M.B.D., J.R.R., D.B.P., and T.W.) and Neurology, Division of Pediatric Neurology (C.A.G.), Washington University School of Medicine, One Children's Place, Suite 4S20, St. Louis, MO 63110. E-mail address for M.B. Dobbs: mattdobbs{at}earthlink.net
2 St. Louis Shriners Hospital for Children, 2001 South Lindbergh Boulevard, St. Louis, MO 63131

Investigation performed at Washington University School of Medicine, St. Louis Children's Hospital, and St. Louis Shriners Hospital for Children, St. Louis, Missouri

The authors did not receive grants or outside funding in support of their research or preparation of this manuscript. They did not receive payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.

A commentary is available with the electronic versions of this article, on our web site (www.jbjs.org) and on our quarterly CD-ROM (call our subscription department, at 781-449-9780, to order the CD-ROM).

Background: The nonoperative technique for the treatment of idiopathic congenital talipes equinovarus (clubfoot) described by Ponseti is a popular method, but it requires two to four years of orthotic management. The purpose of this study was to examine the patient characteristics and demographic factors related to the family that are predictive of recurrent foot deformities in patients treated with this method.

Methods: The cases of fifty-one consecutive infants with eighty-six idiopathic clubfeet treated with use of the Ponseti method were examined retrospectively. The patient characteristics at the time of presentation, such as the severity of the initial clubfoot deformity, previous treatment, and the age at the initiation of treatment, were examined with use of univariate logistic regression analysis modeling recurrence. Demographic data on the family, including annual income, highest level of education attained by the parents, and marital status, as well as parental reports of compliance with the use of the prescribed orthosis, were studied in relation to the risk of recurrence.

Results: The parents of twenty-one patients did not comply with the use of orthotics. Noncompliance was the factor most related to the risk of recurrence, with an odds ratio of 183 (p < 0.00001). Parental educational level (high-school education or less) also was a significant risk factor for recurrence (odds ratio = 10.7, p < 0.03). With the numbers available, no significant relationship was found between gender, race, parental marital status, source of medical insurance, or parental income and the risk of recurrence of the clubfoot deformity. In addition, the severity of the deformity, the age of the patient at the initiation of treatment, and previous treatment were not found to have a significant effect on the risk of recurrence.

Conclusion: Noncompliance and the educational level of the parents (high-school education or less) are significant risk factors for the recurrence of clubfoot deformity after correction with the Ponseti method. The identification of patients who are at risk for recurrence may allow intervention to improve the compliance of the parents with regard to the use of orthotics, and, as a result, improve outcome.

Level of Evidence: Prognostic study, Level II-1 (retrospective study). See Instructions to Authors for a complete description of levels of evidence.


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