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. 2024 Aug 1;44(7):438-442.
doi: 10.1097/BPO.0000000000002686. Epub 2024 Apr 8.

Missed Visits Predict Recurrence in Idiopathic Clubfoot

Armando S Martinez  1 , Grey Loyd  1 , Callie Bridges  1 , Matthew Milad  1 , Nihar Pathare  1 , Luke Doston  1 , Zbigniew Gugala Jr  1 , Jaclyn F Hill  2
Affiliations

Missed Visits Predict Recurrence in Idiopathic Clubfoot

Armando S Martinez et al. J Pediatr Orthop. .

Abstract

Background: Congenital talipes equinovarus, also known as "clubfoot," is a common congenital deformity. While reported relapse rates vary widely, relapse continues to be a common problem faced in the treatment of this condition. The objective of this study is to assess relationships between demographic/socioeconomic factors, follow-up, and rates of relapse in our population of clubfoot patients.

Methods: Retrospective chart review was conducted for patients undergoing treatment for idiopathic clubfoot from February 2012 to December 2022 at a tertiary children's hospital. Records were analyzed for follow-up adherence and recurrence in the Ponseti method, in addition to patient demographic and socioeconomic factors. Statistical analysis was performed to evaluate associations between recurrence, missed clinical visits, and demographic/socioeconomic factors of interest.

Results: Ninety-five patients were included in the study [74.7% male (N=71) and 25.2% female (N=24)]. A total of 64.2% (N=61) of patients developed recurrence during their treatment. Recurrence rates differed significantly by reported bracing noncompliance >1 month (35/46 vs. 26/49, P =0.019), having missed 1 or more clinical visits (38/61 vs. 8/34, P < 0.001), Medicaid or equivalent insurance type (41/56 vs. 20/39, P =0.028), non-white race (47/66 vs. 14/29, P =0.032, higher Social Deprivation Index score (56.13 vs. 41.06, P =0.019). Significant variables were analyzed using a multivariate logistic regression analysis (MVLR). After MVLR, having 1 or more missed clinical visits (OR 4.462, 95% CI: 1.549-12.856) remained significantly associated with increased rates of recurrence. Primary language preference and distance to the hospital were not associated with recurrence.

Conclusions: Higher SDI scores, non-white race, Medicaid insurance, and missed clinical follow-up visits were all associated with increased rates of recurrence for clubfoot patients. Using an MVLR model, missed clinical follow-up visits remained independently associated with increased recurrence rates.

Level of evidence: Level 2-retrospective, prognostic study.

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Conflict of interest statement

The authors declare no conflicts of interest.

References

    1. Bridgens J, Kiely N. Current management of clubfoot (congenital talipes equinovarus). Brit Med J. 2010;340:c355.
    1. Dobbs MB, Rudzki JR, Purcell DB, et al. Factors predictive of outcome after use of the Ponseti method for the treatment of idiopathic clubfeet. J Bone Joint Surg Am. 2004;86:22–27.
    1. Hu W, Ke B, Niansu X, et al. Factors associated with the relapse in Ponseti treated congenital clubfoot. BMC Musculoskelet Disord. 2022;23:88.
    1. Göksan SB, Bilgili F, Eren İ, et al. Factors affecting adherence with foot abduction orthosis following Ponseti method. Acta Orthop Traumatol Turc. 2015;49:620–626.
    1. Van Schelven H, Moerman S, Van der Steen M, et al. Prognostic factors for recurrent idiopathic clubfoot deformity: a systematic literature review and meta-analysis. Acta Orthop. 2022;93:11–28.