# Risk Factors for Relapse and Surgical Intervention in Children with CTEV Treated by Ponseti Method

## TL;DR

This study finds that not following bracing instructions increases the risk of relapse and surgery in children treated for clubfoot using the Ponseti method.

## Contribution

The study identifies brace compliance as the key novel predictor of relapse and surgical intervention in CTEV patients treated with the Ponseti method.

## Key findings

- Non-compliance with bracing significantly increases the risk of relapse and surgical intervention.
- Compliant patients had 90% lower odds of relapse compared to non-compliant patients.
- Most surgical interventions were repeat tenotomies.

## Abstract

The Ponseti method is the gold standard for managing congenital talipes equinovarus (CTEV); however, relapses leading to surgical intervention remain a significant challenge. We investigated the factors associated with a higher risk of relapse. A retrospective study of 31 children (≤4 years) with CTEV treated with the Ponseti method between January 2014 and December 2023 was conducted. Demographic and clinical data—age at treatment, aetiology, Pirani score, number of casts, percutaneous Achilles tenotomy (PAT), surgery, bracing, relapses, and follow-up—were collected. Descriptive statistics, univariate analyses, and logistic regression were conducted to identify risk factors for relapse. Of the 31 patients, 67.7% were male, 58.1% had bilateral involvement and 71.0% had idiopathic CTEV. The median age at presentation was 2 months (IQR 1–3), and the initial Pirani score 5.0, improving to 0.0 at final follow-up (p < 0.001). The median number of casts was 7 (IQR 5–10), which correlated with the initial Pirani score (p = 0.021). PAT was performed in 77.4%; surgical intervention was required in 32.3%, most commonly repeat tenotomy (41.2%). The median bracing duration was 84 weeks (IQR 32–136) with 64.5% compliance. Relapses occurred in 35.5% of cases; 72.7% required recasting and surgery. Logistic regression identified brace compliance (p < 0.001) as the only significant factor; compliant patients had 90% lower odds of relapse. Non-compliance with bracing significantly increases the risk of relapses and surgical intervention in children with CTEV treated by the Ponseti method. Close monitoring and strict adherence to bracing are essential for an optimal outcome.