Serial Casting Before Relapse Surgery: Investigating the Challenges of Relapsed Clubfoot Care

This retrospective cohort study from a single pediatric tertiary center 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 center, and orthosis noncompliance was common.

AI summary · from the full text · reviewed by Pukhraj Gaheer, Medical Student, Queen's University before publishing

Why it mattersRelapse surgery for clubfoot is a common, burdensome pediatric orthopedic problem, and this hypothesis-generating cohort suggests presurgical casting might reduce surgical extent, but the small nonrandomized sample means it cannot yet change practice.

Presenting this at rounds? Start here

• ?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?
• ?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?