title: Predicting the need for surgical intervention in patients with idiopathic clubfoot.
abstract: BACKGROUND
  The purpose of this study was to determine the early factors associated with the need for surgical interventions in patients with idiopathic clubfoot treated with the Ponseti method.
  
  
  METHODS
  All patients with idiopathic clubfoot treated with Ponseti method at our institution with >3 years of follow-up were evaluated. Age at presentation, history of previous treatment, number of casts used, need for percutaneous Achilles tenotomy (PAT), age of initiation of foot abduction orthosis (FAO), compliance with FAO, and need for additional casts were recorded. Dimeglio/Bensahel and Catterall/Piriani scores were recorded at initial presentation, at initiation of FAO, at 1, 2, 3 years of follow-up, and at the most recent follow-up.
  
  
  RESULTS
  Since 2000, 86 patients (134 feet) had >3 years of follow-up from time of initial presentation, and 43 of these feet (32%) had undergone surgery beyond a PAT. Patients who were noncompliant with the FAO were 7.9 times more likely to need surgery than those who were compliant [confidence interval (CI), 2.8-22.0; P<0.001]. Female patients were 5.4 times more likely to need surgery than male patients (CI, 1.8-16.6; P=0.003). For every 1 point increase in Dimeglio/Bensahel score at presentation, patients were 1.3 times more likely to need surgery (CI, 1.0-1.5; P=0.033). For every 1 point increase in Dimeglio/Bensahel score at initiation of the FAO, patients were 1.5 times more likely to need surgery (1.1-2.0, P=0.005). Moreover, for each additional cast required before the initiation of the FAO, patients were 1.5 times less likely to need surgery (CI, 1.1-2.7; P=0.030). No other variable significantly contributed to predicting the need for surgery.
  
  
  CONCLUSIONS
  There are early factors that can be used to predict increased risk for surgical intervention in patients undergoing treatment for idiopathic clubfoot. Female patients and those patients with higher Dimeglio/Bensahel scores at presentation and at initiation of the FAO are at increased risk for needing surgical intervention. Noncompliance with the FAO is associated with the highest risk for surgical intervention.
  
  
  METHODS
  Level III.
authors: *Boston Children's Hospital, Boston, MA †Children's Hospital Los Angeles, Los Angeles, CA ‡NYU Hospital for Joint Diseases, New York, NY.
authors: Rachel Y
authors: RY
authors: Goldstein
authors: Derek A
authors: DA
authors: Seehausen
authors: Alice
authors: A
authors: Chu
authors: Debra A
authors: DA
authors: Sala
authors: Wallace B
authors: WB
authors: Lehman
mesh_terms: D000125:Achilles Tendon / Q000473:pathology / Q000601:surgery; D002675:Child, Preschool; D003025:Clubfoot / Q000209:etiology / Q000601:surgery / Q000628:therapy; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D020380:Needs Assessment; D019637:Orthopedic Procedures / Q000379:methods / Q000706:statistics & numerical data; D009989:Orthotic Devices / Q000706:statistics & numerical data; D010349:Patient Compliance / Q000706:statistics & numerical data; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012737:Sex Factors; D058971:Tenotomy / Q000379:methods / Q000706:statistics & numerical data; D013997:Time Factors