Journal of Pediatric Orthopaedics - 2026-07-22 - Journal Article
Serial Casting Before Relapse Surgery: Investigating the Challenges of Relapsed Clubfoot Care.
Hay K, Gibson N, Knight D, Ng YX, Luo Z, Gibson M, Waller R
Topics
Key Takeaway
Presurgical serial casting before relapse surgery reduced surgical complexity by 40.0% versus 1.9% in uncasted patients (P=0.001) and lowered high-complexity surgery rates from 80.6% to 53.3% (P=0.004).
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Summary
This study asked whether presurgical serial casting reduces the number and complexity of operations for relapsed clubfoot in patients under 16 following initial Ponseti management. A retrospective audit at a single tertiary center compared 14 patients who received presurgical casting against 51 who did not. The casting group achieved a 40.0% reduction in surgical complexity from waitlist to surgery versus 1.9% in controls (P=0.001), with high-complexity procedures occurring in 53.3% versus 80.6% of cases respectively (P=0.004).
Key Limitation
The casting group was only 14 patients, making it impossible to control for confounders such as relapse severity, time to relapse, or surgeon selection bias in who received presurgical casting.
Original Abstract
BACKGROUND
Clubfoot is a common congenital condition typically treated in infancy using the Ponseti method. Despite successful initial treatment, relapse occurs in up to 40% of cases and often requires surgical management. While serial casting is widely used for initial correction, its utility before surgical relapse management remains unclear. This study evaluates whether presurgical casting is associated with a reduction in the number and complexity of surgical procedures for relapsed clubfoot in children under the age of 16 years.
METHODS
A retrospective cohort audit conducted at a tertiary treatment center reviewed children treated surgically for relapsed clubfoot between 2015 and 2024 following initial Ponseti management. Data were extracted from medical records, and participants were stratified into 2 groups: those who received presurgical casting and those who did not. Primary outcomes included the number and complexity of procedures.
RESULTS
Sixty-five participants were included: 14 (21.5%) received presurgical casting. The casting group demonstrated a 40.0% reduction in surgical complexity from waitlist to surgery, while the noncasting group showed only a 1.9% reduction (P=0.001). High-complexity surgeries were less common in the casting group (53.3% compared with the noncasting group, 80.6%, P=0.004). Noncompliance with orthosis use was common, and Indigenous children were overrepresented in the relapse cohort.
CONCLUSION
Presurgical casting may reduce the surgical burden in relapsed clubfoot.
LEVEL OF EVIDENCE
The retrospective comparative study provides a comparison between presurgical casting and noncasting, providing evidence to guide clubfoot service development.