Plaster of Paris versus semirigid fiberglass casting in the Ponseti method for idiopathic clubfoot: a systematic review and a meta-analysis.

Plaster of Paris (POP) is traditional for Ponseti treatment of idiopathic congenital talipes equinovarus (CTEV), but semirigid fiberglass (SRF) is an alternative. This systematic review and meta-analysis compare POP and SRF outcomes. We searched PubMed, Scopus, Cochrane, and EMBASE up to 5th April 2025 for randomized controlled trials (RCTs) and quasi-RCTs comparing POP versus SRF for initial Ponseti treatment of idiopathic CTEV. Eligible studies reported on the number of casts, clinical scores (Dimeglio/Pirani), relapse or skin complications. Risk of bias was assessed using the Cochrane RoB tool. Data were pooled using random-effects meta-analysis [mean difference (MD) for continuous, risk ratio (RR) for binary outcomes]. Four studies (two RCTs, one prospective, one retrospective; 454 feet) met inclusion criteria. Study quality varied. No significant difference was found in the mean number of casts [MD: 0.34, 95% confidence interval (CI): -8.80 to 9.48; two studies, I² = 70.6%], relapse rates (RR: 1.41, 95% CI: 0.04-50.93; two studies, I² = 0.0%), or skin lesions (RR: 0.68, 95% CI: 0.31-1.50; two studies, I² = NA). Evidence certainty was low due to heterogeneity and limited studies. Clinical score analysis was limited by differing scales and missing data; SRF consistently received higher parental satisfaction ratings. Based on limited, low-certainty evidence, no significant difference in clinical efficacy (casts, relapse, skin lesions) was found between POP and SRF. SRF offers advantages in parental satisfaction. Limitations include heterogeneity, few studies per outcome, and inconsistent reporting. While POP is cost-effective, SRF is a viable alternative. Further high-quality RCTs are needed.