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

This retrospective cohort study looked at 65 children under 16 who needed surgery for relapsed clubfoot after prior Ponseti treatment, comparing those who got serial casting before surgery (14 patients) versus those who went straight to surgery (51 patients). The casting group showed a 40.0% reduction in surgical complexity from waitlist to actual surgery, versus only 1.9% reduction in the noncasting group (P=0.001), and had fewer high-complexity surgeries performed (53.3% vs 80.6%, P=0.004). The study also found Indigenous children were overrepresented among relapse cases and often lived far from the treatment center without access to presurgical casting.

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

Why it mattersClubfoot relapse is common and often requires repeat surgery, so any strategy that could reduce surgical burden and complexity is clinically relevant for pediatric orthopedic and physiotherapy teams managing this population.

Presenting this at rounds? Start here

• ?Given that casting assignment was based on nonrandomized surgeon preference with no consistent criteria, and only 14 patients received casting, how much of the observed complexity reduction could reflect selection bias rather than a true treatment effect?
• ?If a center adopts presurgical serial casting before relapse surgery, how should it counterbalance the observed longer delay from relapse detection to surgery (732 vs 499 days) against the potential benefit of reduced surgical complexity?