Factors associated with recurrence of clubfoot treated by the Ponseti method.
OBJECTIVE
To assess several associated factors on the recurrence of clubfoot after successful correction by the Ponseti method.


METHODS
A total of 115 children with 196 clubfeet deformities, treated by the Ponseti method, were evaluated. Demographic data, family history of clubfoot in first-degree relatives, maternal educational level and brace compliance were enquired. Based on their medical files, the characteristics of the patients at the time of presentation such as age, possible associated neuromuscular disease or especial syndrome, severity of the deformity according to the Dimeglio grade and Pirani score, residual deformity after previous Ponseti method and number of casts needed for the correction were recorded.


RESULTS
There were 83 boys (72.2%) and 32 girls (27.8%) with a male to female ratio of 2.6. The mean age at the initiation of treatment was 5.4 d (range: 1 to 60 d). The average number of casts applied to achieve complete correction of all clubfoot deformities was 4.2. Follow-up range was 11 to 60 mo. In total, 39 feet had recurrence with a minimum Dimeglio grade of 1 or Pirani score of 0.5 at the follow-up visit. More recurrence was observed in non-idiopathic clubfoot deformities (P= 0.001), non-compliance to wear braces (P< 0.001), low educational level of mother (P= 0.033), increased number of casts (P< 0.001), and more follow-up periods (P< 0.001). No increase in the possibility of recurrence was observed when the previous unsuccessful casting was further treated using the Ponseti method (P= 0.091). Also, no significant correlation was found for variables of age (P= 0.763), Dimeglio grade (P= 0.875), and Pirani score (P= 0.624) obtaining at the beginning of the serial casting.


CONCLUSIONS
Using the Ponseti method, non-idiopathic clubfoot, non-compliance to wear braces, low educational level of mother, increased number of casts and more follow-up periods had more association to possible increase in recurrence rate after correction of clubfoot deformity.
Mohammad Reza Azarpira, Mohammad Jafar Emami, Amir Reza Vosoughi, Keivan Rahbari, Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz 71948-15644, Iran.
Mohammad Reza
MR
Azarpira
Mohammad Reza Azarpira, Mohammad Jafar Emami, Amir Reza Vosoughi, Keivan Rahbari, Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz 71948-15644, Iran.
Mohammad Jafar
MJ
Emami
Mohammad Reza Azarpira, Mohammad Jafar Emami, Amir Reza Vosoughi, Keivan Rahbari, Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz 71948-15644, Iran.
Amir Reza
AR
Vosoughi
Mohammad Reza Azarpira, Mohammad Jafar Emami, Amir Reza Vosoughi, Keivan Rahbari, Bone and Joint Diseases Research Center, Shiraz University of Medical Sciences, Shiraz 71948-15644, Iran.
Keivan
K
Rahbari
Cast; Clubfoot; Ponseti; Recurrence; Talipes equinovarus