Abstract
Background and purpose — After initial clubfoot correction through Ponseti treatment, recurrence rates range from 26% to 48%. Even though various factors have been associated with increased recurrence risk, systematic assessments of the prognostic capacity of recurrence risk factors and their clinical relevance are lacking. Therefore we assessed clinically relevant prognostic factors for recurrent idiopathic clubfoot deformity after initial correction through Ponseti treatment. Methods — PubMed, Embase, Cinahl, and Web of Science were systematically searched for studies investigating the association between clinically relevant factors and recurrence rates. Prognostic factors were qualitatively assessed and included in the meta-analysis if ≥ 2 studies investigated the same factor and methods were comparable. Results — 34 articles were included in the qualitative synthesis, of which 22 were also included in the meta-analysis. Meta-analysis revealed that poor evertor muscle activity (OR = 255, 95% CI 30–2,190), brace non-compliance (OR = 10, CI 5–21), no additional stretching (OR = 31, CI 10–101), more casts (OR = 3.5, CI 1.6–7.8), lower education level of parents (OR = 1.8, CI 1.2–2.6), non-marital status of parents (OR = 1.8, CI 1.1–3.0), and higher Dimeglio scores (OR = 1.9, CI 1.2–3.3) were associated with higher recurrence rates. Interpretation — Brace non-compliance and poor evertor muscle activity have been identified as main recurrence risk factors and are therefore important to be closely monitored during clinical follow-up of clubfoot patients. Adding additional stretching during the bracing protocol might be promising in the quest to prevent relapse, but scientific evidence for clear clinical treatment recommendations is still limited.
Highlights
Interpretation — Brace non-compliance and poor evertor muscle activity have been identified as main recurrence risk factors and are important to be closely monitored during clinical follow-up of clubfoot patients
Eligibility criteria and study selection Studies were included if (i) written in English, Dutch, or German, (ii) patients were diagnosed with idiopathic clubfoot deformity and (iii) treated according the Ponseti method, (iv) included the occurrence of recurrent clubfeet deformity, (v) provided statistical assessments of an association between clubfoot recurrence and prognostic factor(s) in terms of odds ratio or other risk estimates such as hazard ratios
Musculoskeletal factors 23 studies assessed the association of recurrence rates and 9 musculoskeletal factors (Table 2). 3 factors could be included in a meta-analysis
Summary
Prognostic factors for recurrent idiopathic clubfoot deformity van Schelven, Heleen; Moerman, Sophie; van der Steen, Marieke; Besselaar, Arnold T.; Greve, Christian. Citation for published version (APA): van Schelven, H., Moerman, S., van der Steen, M., Besselaar, A. More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverneamendment. Take-down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. For technical reasons the number of authors shown on this cover page is limited to 10 maximum
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