Factors Associated With Recurrence After Use Of The Ponseti Method For The Treatment Of Congenital Talipes Equinovarus

BACKGROUNDClubfoot is a congenital deformity that historically has been difficult to correct and difficult to maintain once corrected. Its treatment has been controversial in the past. Long-term followup showing clubfeet treated by extensive surgery led to a worse quality of life in adulthood has contributed to a decline in the enthusiasm for surgery. In the last decade,the Ponseti method has become increasingly popular and is widely practiced worldwide,but subsequent relapses may occur in up to14%～41%of patients. The purpose of this study was to determine the factors that might be predictive of recurrence. Recognition of important risk factors may eventually result in better patient selection for the currently available treatments of idiopathic clubfeet and may allow early intervention to improve compliance and outcome.OBJECTIVETo evaluate the clinical factors associated with recurrence after use of the Ponseti method for the treatment of congenital talipes equinovarus.METHODSA total number of378patients with544clubfeet underwent conservative treatment with Ponseti method from March2002to November2007.119cases (173clubfeet) with a minimum5years followup were involved in this retrospectively study. Out of119patients,90patients were male.43patients with57clubfeet were diagnosised with relapsing clubfeet. The average age at the time of treatment was (3.55±3.22) months (range:1day-14months). The patient characteristics at the time of presentation, such as gender, the age at the initiation of treatment, side of involvement, need for achilles tenotomy, the pirani score of the initial clubfoot deformity, number of casts, and orthosis compliance were examined with use of single factor analysis and logistic regression analysis modeling recurrence.RESULTSThe single factor analysis showed the noncompliance(χ2=74.12,p=0.000),initial pirani score(t=3.24,p=0.001),number of casts(t=2.26,p=0.025) were significantly different between two groups, while the other factors were not statistically significant. Logistic regression analysis showed noncompliance(odds ratio=112.60, p=0.000)and initial pirani score(odds ratio=5.02, p=0.000) were independent factors for recurrence.CONCLUSIONSNoncompliance and the high pirani score are significant risk factors for the recurrence of clubfoot deformity after correction with the Ponseti method. Improving compliance with the use of orthosis is essential to control recurrence. In older to identify progressive deformity as early as possible to allow timely intervention, a more vigilant follow-up schedule is advised for the patients with high initial pirani score.