Retrospective cohort study of 51 infants (86 clubfeet) treated with the Ponseti method by a single surgeon. Uses univariate logistic regression to identify which patient and family factors predict deformity recurrence. Asks: does failure come from the foot, or from the family?
The Ponseti method almost never fails at the casting stage — 100% of feet in this series achieved initial correction. Failure is a compliance problem, not a technical one.
When you see a family with parental education at the high-school level or below, flag them early. Their child has a tenfold higher recurrence risk. Intensive nursing phone follow-up, visual/pictorial educational materials, and explicit discussions of the two-to-four year brace commitment should start at the first visit, not after the first relapse.
The Denis Browne bar orthosis must be worn 22–23 hours per day for 2–3 months, then 10–12 hours nightly for up to four years. The most common reason families stopped was inconvenience in that first full-time phase. Anticipatory counseling about this transition point is a concrete intervention.
This paper is the evidence base for why clubfoot clinics now use dedicated nursing coordinators and compliance tracking. The casting is the easy part. Building a compliant family is the treatment.
Retrospective cohort study of 51 infants (86 clubfeet) treated with the Ponseti method by a single surgeon. Uses univariate logistic regression to identify which patient and family factors predict deformity recurrence. Asks: does failure come from the foot, or from the family?
The Ponseti method almost never fails at the casting stage — 100% of feet in this series achieved initial correction. Failure is a compliance problem, not a technical one.
When you see a family with parental education at the high-school level or below, flag them early. Their child has a tenfold higher recurrence risk. Intensive nursing phone follow-up, visual/pictorial educational materials, and explicit discussions of the two-to-four year brace commitment should start at the first visit, not after the first relapse.
The Denis Browne bar orthosis must be worn 22–23 hours per day for 2–3 months, then 10–12 hours nightly for up to four years. The most common reason families stopped was inconvenience in that first full-time phase. Anticipatory counseling about this transition point is a concrete intervention.
This paper is the evidence base for why clubfoot clinics now use dedicated nursing coordinators and compliance tracking. The casting is the easy part. Building a compliant family is the treatment.