Comparing the Clinical Outcomes and Child Opportunity Index of Patients With Congenital Talipes Equinovarus After Early Treatment (<4 Wk Old) and Late Treatment (≥ 4 Wk Old).

Abstract

Background: Clubfoot is the most common congenital abnormality of the lower extremity. The widely accepted Ponseti casting method includes a series of manipulations and casts often followed by Achilles tenotomy then use of a foot abduction orthosis. Some evidence suggests initiation of casting within a week of age improves outcomes but access to care and socioeconomic factors can impact timing of casting initiation. This study evaluates differences in clinical outcomes, demographic variables, and Child Opportunity Index (COI) between patients who initiated treatment before and after 4 weeks of age.

Methods: This was a retrospective study on patients with idiopathic clubfoot treated with the Ponseti method at a tertiary care center between 2011 and 2023. Patients were categorized into 2 groups by age at initial cast: early treatment (<4 wk) and late treatment (≥4 wk to 6 mo). Demographic and clinical data were collected, including treatment outcomes and bracing issues, and COI scores were recorded.

Results: Seventy-eight patients were included: 60 in the early group (92 feet) and 18 in the late group (25 feet). Groups differed significantly by age at initiation of casting (P=<0.001). There were no significant differences in other demographic characteristics or insurance type. Patients in the late group were more likely to experience non-skin-related bracing issues (P=0.047). No significant differences were found in other clinical or bracing outcomes. Patients in the late group were more likely to have a low/very low total COI (P=0.008). There were no significant differences in domain-specific COI scores (health, socioeconomic, education).

Conclusions: Clubfoot patients who initiated treatment ≥4 weeks had a lower total COI, indicating that socioeconomic factors may be associated with delayed treatment. Although patients in the late group experienced more non-skin-related bracing issues, there were no significant differences in other clinical outcomes when compared with those treated at <4 weeks of age. These findings may alleviate pressure to initiate treatment by the first week of life when there are barriers to accessing care that can be overcome within a month and highlight the need for providers to consider socioeconomic profiles in treatment planning.

Level of evidence: This was a retrospective cohort study comparing 2 methods of treatment between 2 patient groups, making it a level III therapeutic study.