Early Outcomes of Ponseti Treatment for Idiopathic and Non-Idiopathic Clubfoot at a Philippine Tertiary Government Hospital

Abstract

Background. The Ponseti method achieves less predictable outcomes and higher workloads in rigid non-idiopathic clubfoot compared to idiopathic cohorts. Structural and socioeconomic barriers further complicate management in low- and middle-income countries.

Objective. The purpose of the study was to evaluate the early outcomes of Ponseti treatment for both idiopathic and non-idiopathic clubfoot in a Philippine tertiary government hospital setting.

Methodology. This retrospective chart review (August 2019 to December 2023) evaluated early Ponseti outcomes at BGHMC. Through total enumeration, 42 eligible patients aged ≤ 2 years (36 idiopathic, 6 non-idiopathic) were analyzed. Initial clinical success was defined as achieving an initial plantigrade foot (Pirani score ≤ 0.5), allowing transition into a minimum of six months of maintenance bracing.

Results. Baseline severity was high across both cohorts (median Pirani 5.5 idiopathic vs. 6.0 non-idiopathic). The early clinical success rate was 100%, enabling all feet to complete initial casting and transition into bracing with 100% full short-term brace compliance documented at six months. Univariate linear regression demonstrated that a non-idiopathic etiology was a strong predictor of an increased casting workload (B = 2.085, 95% CI [0.56, 3.61], p = 0.008), requiring approximately two additional casts. Etiology did not significantly predict baseline severity, pre-tenotomy casting duration, or percutaneous Achilles tenotomy rates, which were uncommonly low (~36% for both groups). Early deformity recurrence within the limited follow-up period (maximum 13 months) occurred exclusively in idiopathic feet (12.07%).

Conclusion. The Ponseti method achieves favorable initial clinical correction and short-term brace compliance during early maintenance across both cohorts. However, conclusions are strictly limited by a small non-idiopathic sample size and a short follow-up duration. Given an uncommonly low institutional tenotomy rate (~36%) that deviates from global benchmarks, this cohort faces a high risk for late, weight-bearing relapses and requires strict longitudinal surveillance up to at least age 5 years.