title: The impact of the Ponseti treatment method on parents and caregivers of children with clubfoot: a comparison of two urban populations in Europe and Africa.
abstract: OBJECTIVE
  With the Ponseti treatment method established as the gold standard, children with clubfeet face a prolonged treatment regime that might impact on their families. We aimed to determine how Ponseti treatment influences the lives of parents and caregivers and what coping strategies they use. Secondarily, we aimed to identify any potential differences between two urban referral centres for clubfoot.
  
  
  METHODS
  A total of 115 parents of children affected with idiopathic clubfoot were recruited and included in two groups: one from the United Kingdom (UK) and the other from South Africa (SA). The participants completed the following three instruments: the Impact on Family Scale (IOFS), the Multidimensional Scale of Perceived Social Support (MSPSS), and the Brief COPE.
  
  
  RESULTS
  During the bracing phase, the IOFS showed a trend towards lower scores when compared to the casting phase for both cohorts (p = 0.247 and p = 0.434, respectively). The SA population scored higher than the UK in the MSPSS in both casting (p = 0.002) and bracing phases (p = 0.004) and used coping strategies at a significantly higher level when compared to the UK population (p < 0.05) in both treatment phases.
  
  
  CONCLUSIONS
  This is the first study to show that Ponseti treatment for clubfoot causes an impact on family function. In SA, perceived social support is higher and coping strategies are used more often than in the UK to deal with the stressful circumstances of treatment.
authors.affiliation: Paediatric Orthopaedics, Department of Orthopaedic and Trauma Surgery, Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London, E1 1BZ, UK. fmalagelada@gmail.com.
authors.forename: Francesc
authors.initials: F
authors.lastname: Malagelada
authors.affiliation: Paediatric Orthopaedics, Department of Orthopaedic Surgery, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.
authors.forename: Sadia
authors.initials: S
authors.lastname: Mayet
authors.affiliation: Paediatric Orthopaedics, Department of Orthopaedic Surgery, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.
authors.forename: Greg
authors.initials: G
authors.lastname: Firth
authors.affiliation: Paediatric Orthopaedics, Department of Orthopaedic and Trauma Surgery, Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, London, E1 1BZ, UK.
authors.forename: Manoj
authors.initials: M
authors.lastname: Ramachandran
keywords: Clubfoot; Congenital talipes equinovarus; Coping; Ponseti; Social support; Stress