# Correlation Between Socioeconomic Status and Brace Compliance in Idiopathic Clubfoot Deformities

## TL;DR

This study found that socioeconomic factors do not affect brace compliance in treating clubfoot in infants, but missing appointments increases noncompliance and recurrence risks.

## Contribution

The study provides new evidence that socioeconomic status does not influence brace compliance in idiopathic clubfoot treatment.

## Key findings

- No significant correlations were found between socioeconomic factors and brace compliance.
- Noncompliance odds were 7.0 times higher for patients missing clinic appointments.
- Recurrence odds were 74.8 times higher for noncompliant patients compared to compliant ones.

## Abstract

Background: Congenital talipes equinovarus (CTEV), or clubfoot, is one of the most common foot deformities seen at birth. The Ponseti technique is the most common method to treat clubfoot and consists of gentle manipulation with serial casting, a percutaneous Achilles tendon tenotomy, and bracing for the first few years of life. The purpose of this study was to determine whether socioeconomic factors influence compliance with clubfoot bracing for families with infants who have idiopathic clubfoot treated by the Ponseti method.

Methodology: All patients with clubfoot deformity who began primary treatment at our pediatric orthopedic clinic between February 2018 and May 2021 were included in a retrospective chart review. Compliance was defined as strict adherence to the initial casting and tenotomy appointments, in addition to the caregiver's reported compliance with brace wear, and no mention of non-compliance in the patient’s medical record. Recurrence was defined as relapse of the deformity after at least one year of follow-up and/or the need for additional casting or tenotomy.

Results: Forty-three patients were included in the final analysis of compliance with bracing. No significant correlations were seen between the rate of compliance with bracing and any of the socioeconomic factors assessed in this study. The odds of noncompliance were 7.0 times higher in patients who had one or more missed clinic appointments, compared to those who attended all appointments (P = 0.01). Forty-one patients were analyzed at a minimum one-year follow-up for recurrence of deformity. The odds ratio for recurrence of deformity in patients who were noncompliant with bracing was 74.8 compared to those who were compliant (P =< 0.001).

Conclusions: Socioeconomic factors, including household income, education level, zip code, employment status of caregivers, and insurance status, were not associated with bracing compliance or recurrence of the clubfoot deformity. This was a level 2 observational study.