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Background <p>While the Ponseti method is the gold standard for treatment of congenital clubfoot, recurrence after initial correction remains common. Most published data describing management of recurrent deformity are derived from single center series, and national practice patterns are not well defined. The purpose of this study was to characterize contemporary utilization of interventions used as proxies for clubfoot recurrence in a large multi-institutional database.</p> Materials and methods <p>We conducted a retrospective descriptive study using the TriNetX Research Network. Children diagnosed with idiopathic clubfoot at one year of age or younger were identified and followed longitudinally for up to seven years after an index ambulatory visit. Relapse related interventions were defined using CPT codes and included repeat casting, repeat Achilles tenotomy, tibialis anterior tendon transfer, and bony osteotomies. Kaplan Meier analyses were used to estimate the cumulative probability of remaining free from each intervention over time.</p> Results <p>The final cohort included 4,522 children with early diagnosed idiopathic clubfoot and longitudinal follow up. Any relapse-related intervention occurred in 23.11% of children, with repeat casting being the most common (16.08%). Tibialis anterior tendon transfer was performed in 6.23% and repeat Achilles tenotomy in 5.75% of eligible patients. Bony procedures were uncommon, with calcaneal osteotomy performed in 0.75%, tarsal osteotomy in 1.64%, and first metatarsal osteotomy in 0.27% of children. Kaplan Meier estimates demonstrated that casting and tendon procedures occurred earlier in childhood, whereas osteotomies were rare late interventions with procedural free survival exceeding 97% at seven years.</p> Conclusions <p>In this large national cohort of children with idiopathic clubfoot, procedure-based interventions consistent with recurrence occurred in approximately one-quarter of patients, with repeat casting representing the predominant management strategy. Tendon procedures were used selectively, and bony procedures were rare, reinforcing their role as salvage interventions for rigid or multiply recurrent deformities. These population level data provide contemporary benchmarks for counseling families, guiding expectations, and informing future research on recurrence management following Ponseti treatment.</p>

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Contemporary national treatment patterns for clubfoot relapse-related interventions: a large multi-institutional cohort

  • 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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  • Christopher D. Hamad,
  • Joshua Wiener,
  • Timothy Liu,
  • Autreen Golzar,
  • Al-Hassan J. Dajani,
  • David C. Kaelber,
  • Nicholas M. Bernthal,
  • William L. Sheppard,
  • Soroush Baghdadi,
  • Mauricio Silva

摘要

Background

While the Ponseti method is the gold standard for treatment of congenital clubfoot, recurrence after initial correction remains common. Most published data describing management of recurrent deformity are derived from single center series, and national practice patterns are not well defined. The purpose of this study was to characterize contemporary utilization of interventions used as proxies for clubfoot recurrence in a large multi-institutional database.

Materials and methods

We conducted a retrospective descriptive study using the TriNetX Research Network. Children diagnosed with idiopathic clubfoot at one year of age or younger were identified and followed longitudinally for up to seven years after an index ambulatory visit. Relapse related interventions were defined using CPT codes and included repeat casting, repeat Achilles tenotomy, tibialis anterior tendon transfer, and bony osteotomies. Kaplan Meier analyses were used to estimate the cumulative probability of remaining free from each intervention over time.

Results

The final cohort included 4,522 children with early diagnosed idiopathic clubfoot and longitudinal follow up. Any relapse-related intervention occurred in 23.11% of children, with repeat casting being the most common (16.08%). Tibialis anterior tendon transfer was performed in 6.23% and repeat Achilles tenotomy in 5.75% of eligible patients. Bony procedures were uncommon, with calcaneal osteotomy performed in 0.75%, tarsal osteotomy in 1.64%, and first metatarsal osteotomy in 0.27% of children. Kaplan Meier estimates demonstrated that casting and tendon procedures occurred earlier in childhood, whereas osteotomies were rare late interventions with procedural free survival exceeding 97% at seven years.

Conclusions

In this large national cohort of children with idiopathic clubfoot, procedure-based interventions consistent with recurrence occurred in approximately one-quarter of patients, with repeat casting representing the predominant management strategy. Tendon procedures were used selectively, and bony procedures were rare, reinforcing their role as salvage interventions for rigid or multiply recurrent deformities. These population level data provide contemporary benchmarks for counseling families, guiding expectations, and informing future research on recurrence management following Ponseti treatment.