Patient-Reported Outcomes in Children With Idiopathic Clubfoot Deformity Treated With Ponseti Casting: Does Recurrence of the Deformity Play a Role?

Abstract

Introduction: Despite the high effectiveness of Ponseti casting in treating idiopathic clubfoot, patient-reported outcomes (PROs) are not studied well in the literature, necessitating further investigation into PROs to evaluate the effect on patients' lives. We used the Patient-Reported Outcomes Measurement Information System (PROMIS) to evaluate PROs in children with Ponseti-treated clubfoot and assess the effect of recurrence on these PROs.

Methods: This study retrospectively reviewed medical records from patients ages 5 to 18 years treated for idiopathic clubfoot at a single institution from 2002 to 2023 with available PROMIS data for mobility, pain, and peer relationships. Exclusion criteria included initial treatment other than Ponseti casting, presentation to our institution after age 2 years, and PROMIS scores taken less than 6 months postsurgery. Recurrence was defined as patients who required further treatment with casting or surgery after initial correction.

Results: Among 50 patients eligible for this study, 78% (39) were male and 34% (17) had bilateral clubfoot. Average age when the most recent PROMIS data were collected was 6.1 years. Average PROMIS scores were 51.1 mobility, 44.2 pain interference, and 51.9 peer relationships. Notably, patients with recurrence showed similar PROMIS scores across all domains when compared with nonrecurrent patients: 50.7 ± 8.1 vs. 51.5 ± 9.8 ( P = 0.753) mobility, 45.5 ± 8.9 vs. 43.1 ± 8.7 ( P = 0.334) pain interference, and 52.5 ± 9.7 vs. 51.3 ± 9.1 ( P = 0.634) peer relationships.

Conclusion: To our knowledge, this is the first study to use PROMIS scores to evaluate the effect of recurrence on PROs in children with Ponseti-treated clubfoot. The findings of this study suggest that children who sustained recurrence did not have markedly different PROMIS outcomes compared with nonrecurrent children, regardless of treatment modality for recurrence, indicating limited effect of recurrence on PROs at an average 5-year follow-up.