Serial Casting Before Relapse Surgery: Investigating the Challenges of Relapsed Clubfoot Care
Journal of Pediatric Orthopaedics · 22 Jul 2026
† Impact is the editorial-priority score. All scores are out of 100. Clinical is a stored clinical-importance score from the earlier method; it has not been recalculated.
Why it matters
Relapse surgery for clubfoot is a common, burdensome paediatric orthopaedic problem, and this hypothesis-generating cohort suggests presurgical casting might reduce surgical extent, but the small nonrandomised sample means it cannot yet change practice.
The evidence
This retrospective cohort study from a single paediatric tertiary centre compared 65 children under 16 who needed surgery for relapsed clubfoot after initial Ponseti treatment, 14 of whom received presurgical serial casting versus 51 who went straight to surgery. The casting group had a larger drop in surgical complexity from waitlist to actual surgery (40.0% reduction) versus the non-casting group (1.9% reduction, P=0.001), and fewer high-complexity surgeries (53.3% vs 80.6%, P=0.004). The study also found Indigenous children were overrepresented among relapse cases and lived far from the treatment centre, and orthosis noncompliance was common.
A coherent primary effect estimate is unavailable. Clinical relevance does not estimate treatment benefit.
Why this rigour score?
Retrospective cohort
Methods at a glance
Recorded assessment- Confounding adjustmentUnadjusted only
- Covariate balance confirmedNot reported
- Outcome assessors blindedNot met
- Comparable start of follow-upNot met
- Adequate statistical powerCalculation absent
- Prospective registrationNot met
Not reported does not mean not done. Checks have different weights; this is not a count of boxes ticked.
How to read this assessment
The recorded methods are shown alongside the published score. A verified point-by-point calculation is not available for this version of the appraisal.
Checklist from the stored appraisal. “Not met” describes the recorded criterion; it does not always produce a deduction. This overview supports reading the full study.
For journal club
1.Given that casting group assignment was based on unstandardized surgeon preference and the two groups differed in waitlist complexity and physiotherapy involvement, how much of the observed complexity reduction could be due to selection or regression to the mean rather than a true casting effect?
2.If you were setting up a relapsed clubfoot pathway, would this preliminary retrospective data be enough to justify adding presurgical serial casting for all patients, given the added time to surgery and resource burden?
Original publication title
Serial Casting Before Relapse Surgery: Investigating the Challenges of Relapsed Clubfoot Care