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Background <p>The Ponseti method is the current global standard for the management of idiopathic clubfoot and achieves high initial correction rates. However, relapse during childhood remains a clinically important challenge, with widely varying estimates reported across studies. This systematic review and meta-analysis aimed to estimate the pooled prevalence of relapse following Ponseti treatment and synthesize associated risk factors.</p> Methods <p>A systematic search of PubMed/MEDLINE, Scopus, and Web of Science was conducted for studies published between 1 January 2015 and 30 January 2026. Observational studies evaluating relapse in children (0–18&#xa0;years) with idiopathic clubfoot treated using the Ponseti method were included. Random-effects meta-analysis with logit-transformed proportions was used to estimate pooled relapse prevalence. Heterogeneity was assessed using I<sup>2</sup> and τ<sup>2</sup>, and prediction intervals were calculated. Risk of bias was assessed using the Joanna Briggs Institute (JBI) checklist for prevalence studies and the Quality in Prognosis Studies (QUIPS) tool for prognostic factor studies. Subgroup, sensitivity, and meta-regression analyses were performed. Publication bias was assessed using funnel plots and Egger’s test.</p> Results <p>Twenty-five studies involving 1,624 children met the inclusion criteria. In the primary analysis restricted to patient-level data, the pooled relapse prevalence was 26.4% (95% CI 20.4–33.5%), while sensitivity analysis including mixed units of analysis yielded a slightly lower estimate of 22.4% (95% CI 17.9–27.7%). Substantial heterogeneity was observed (I<sup>2</sup> ≈ 75%), with a wide prediction interval (approximately 10–38%). Brace non-compliance was strongly associated with relapse (pooled OR 22.35, 95% CI 10.09–49.53). Higher baseline severity and delayed treatment initiation were also associated with increased relapse risk. Definitions of relapse varied considerably across studies, contributing to heterogeneity in pooled estimates. Sensitivity analyses supported the stability of findings. There was borderline evidence of small-study effects.</p> Conclusions <p>Relapse following Ponseti treatment remains clinically significant, affecting approximately one in four to one in five children. Brace non-compliance is the most important modifiable factor associated with relapse. Variability in relapse definitions, follow-up duration, and program implementation likely contribute to heterogeneity in reported outcomes. Strengthening brace adherence, ensuring prolonged follow-up, and standardizing clinically meaningful relapse definitions may improve long-term outcomes.</p>

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Global prevalence, patterns, and predictors of relapse following Ponseti treatment for idiopathic clubfoot: a systematic review and meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月28日

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  • Victor Ogutu,
  • Ewochu Emmanuel Jacob,
  • Bienfait Mumbere Vahwere,
  • Augusine Oviosun,
  • Chinyere N. Anyanwu,
  • Wusa Makena,
  • Ugwu Okechukwu Paul Chima,
  • Okon Michael Ben,
  • Swase Dominic Terkimbi,
  • Emeka Godson Anyanwu

摘要

Background

The Ponseti method is the current global standard for the management of idiopathic clubfoot and achieves high initial correction rates. However, relapse during childhood remains a clinically important challenge, with widely varying estimates reported across studies. This systematic review and meta-analysis aimed to estimate the pooled prevalence of relapse following Ponseti treatment and synthesize associated risk factors.

Methods

A systematic search of PubMed/MEDLINE, Scopus, and Web of Science was conducted for studies published between 1 January 2015 and 30 January 2026. Observational studies evaluating relapse in children (0–18 years) with idiopathic clubfoot treated using the Ponseti method were included. Random-effects meta-analysis with logit-transformed proportions was used to estimate pooled relapse prevalence. Heterogeneity was assessed using I2 and τ2, and prediction intervals were calculated. Risk of bias was assessed using the Joanna Briggs Institute (JBI) checklist for prevalence studies and the Quality in Prognosis Studies (QUIPS) tool for prognostic factor studies. Subgroup, sensitivity, and meta-regression analyses were performed. Publication bias was assessed using funnel plots and Egger’s test.

Results

Twenty-five studies involving 1,624 children met the inclusion criteria. In the primary analysis restricted to patient-level data, the pooled relapse prevalence was 26.4% (95% CI 20.4–33.5%), while sensitivity analysis including mixed units of analysis yielded a slightly lower estimate of 22.4% (95% CI 17.9–27.7%). Substantial heterogeneity was observed (I2 ≈ 75%), with a wide prediction interval (approximately 10–38%). Brace non-compliance was strongly associated with relapse (pooled OR 22.35, 95% CI 10.09–49.53). Higher baseline severity and delayed treatment initiation were also associated with increased relapse risk. Definitions of relapse varied considerably across studies, contributing to heterogeneity in pooled estimates. Sensitivity analyses supported the stability of findings. There was borderline evidence of small-study effects.

Conclusions

Relapse following Ponseti treatment remains clinically significant, affecting approximately one in four to one in five children. Brace non-compliance is the most important modifiable factor associated with relapse. Variability in relapse definitions, follow-up duration, and program implementation likely contribute to heterogeneity in reported outcomes. Strengthening brace adherence, ensuring prolonged follow-up, and standardizing clinically meaningful relapse definitions may improve long-term outcomes.