Timing for Ponseti clubfoot management: does the age matter? 90 children (131 feet) with a mean follow-up of 5 years

Figures & data

Figure 1. Flowchart of patients with idiopathic clubfoot.

Figure 2. Foot-abduction brace was applied in our clinics. The brace consists of a bar with the shoes attached at 60–70° of abduction on the affected side and 30–40° on the normal side.

Figure 3. Relapse was identified at 4 years of age for poor brace compliance. Right clubfoot: Dimeglio score =8. (A) Forefoot adductus, (B) No obvious varus deformity, (C) Lateral edge curve, (D) Equinus deformity, (E) Standing anteroposterior views: reduced talocalcaneal angle, (F) Standing lateral views: reduced talocalcaneal angle and flat-top talus.

Figure 4. The same patient after repeated Ponseti treatment: ICFSG =4. (A–C) Morphology evaluation =1, (D) Muscle function =0, (E) Radiologic evaluation =3, (F) Gait analysis: dynamic function =0.

Table 1. Demographic data with reference to age when clubfoot management was initiated

	Group I	Group II	Group III
No. of cases (feet)	30 (43)	36 (56)	24 (32)
Age at presentation range	13 days	47 days	4.5 months
	(2–27)	(29–90)	(3–6)
Sex
Male	25	29	18
Female	5	7	6
Side
Bilateral	13	20	8
Unilateral	17	16	16
Initial Pirani score^c	4.8 (0.9)	4.3 (1.1)	4.3 (0.7)
Initial Dimeglio score^c	14 (3.5)	13 (3.1)	13 (2.7)
No. of casts before PAT^c	4.5 (1.6)^a	3.7 (1.2)	4.2 (1.4)^a
PAT rate^d
Yes	28 (40)	29 (46)	22 (28)
No	2 (3)	7 (10)	2 (4)
Initial correction rate^d
Yes	22 (33)	33 (51)	20 (26)
No	8 (10)	3 (5)	4 (6)
Brace compliance^d
Yes	25 (35)	30 (46)	1 8 (26)
No	5 (8)	6 (10)	6 (6)
Relapse rate^d
Yes	7 (14)	4 (6)^b	2 (2)
No	23 (29)	32 (50)	22 (30)
Dorsal flexion (°)^c	13.7 (9.2)	15.2 (8.3)	14.8 (7.9)
Mean follow-up (years)^c	4.9 (1.2)	4.7 (0.7)	4.9 (0.7)
Final Dimeglio score^c	4.3 (1.3)	4.1 (0.8)	4.1 (0.6)
ICFSG score^d	24 (34)	21 (35)	14 (18)
Total score^c	4.6 (1.4)	3.9 (2.2)	6.3 (1.1) ^a,b

Group I (≤ 28 days), Group II (> 28 days to ≤3 months), Group III (> 3 months to ≤6 months);

a p < 0.05 compared with Group II.

b p < 0.05 compared with Group I.

c values are mean (SD)

d values are cases (feet)

Table 2. Linear regression of ICFSG score with clinical characteristics (n = 59)

Variables	Univariable linear regression β (95% CI)	Multivariable linear regression p-value	β (95% CI)	p-value
Presentation age (days)	0.017 (0.007 to 0.027)	0.002	0.019 (0.009–0.029)	< 0.001
Sex	0.18 (–1.3 to 1.7)	0.8	–	–
Side	–0.14 (–1.2 to 0.9)	0.8	–	–
Initial Pirani score	–0.51 (–1.0 to –0.02)	0.04	–0.11	0.4
Initial Dimeglio score	–0.16 (–0.3 to –0.01)	0.04	–0.22	0.08
No. of casts	0.18 (–0.2 to 0.6)	0.3	–	–
PAT	–1.23 (–2.8 to 0.3)	0.1	–	–
Compliance	0.47 (–0.9 to 1.8)	0.5	–	–
Relapse	–0.04 (–1.5 to 1.5)	1.0	–	–

ICFSG: International Clubfoot Study Group score.

Table 3. Demographic data after propensity score matching

	Group I	Group II	Group III
No. of cases (feet)	15 (25)	15 (24)	10 (16)
Age at presentation	13 days	45 days	4.6 months
range	(3–27)	(31–87)	(3–6)
Sex
Male	12	13	8
Female	3	2	2
Side
Bilateral	10	9	6
Unilateral	5	6	4
Initial Pirani score ^c	4.6 (0.9)	4.5 (1.2)	4.1 (0.7)
Initial Dimeglio score ^c	14 (3.9)	13 (3.9)	14 (1.2)
No. of casts before PAT ^c	4.3 (1.8)	3.5 (0.9)	4.4 (1.0)
PAT rate ^d
Yes	13 (22)	13 (22)	10 (16)
No	2 (3)	2 (2)	0 (0)
Brace compliance ^d
Yes	13 (21)	13 (21)	6 (12)
No	2 (4)	2 (3)	4 (4)
Relapse rate ^d
Yes	5 (10)	2 (3)	2 (2)
No	10 (15)	13 (21)	8 (14)
Propensity score ^c	0.5 (0.2)	0.5 (0.2)	0.6 (0.2)
ICFSG score ^c	4.9 (1.6)	3.9 (2.2)	6.8 (1.1) ^a,b

For footnotes see Table 1.