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Treatment of Congenital Clubfoot with the Ponseti Method: The Parents' Perspective

Sunday, October 21, 2012: 8:28 AM
Melrose (Hilton Riverside)
Monica Paschoal Nogueira, M.D./, Ph.D.1, Kathleen Kennedy Miller, B.A., Medical, Student2, Mark H. Fox2 and Jose Morcuende, M.D., Ph.D.3, (1)Public Health, University of São Paulo, Sao Paulo, Brazil, (2)Carver College of Medicine, University of Iowa, Iowa City, IA, (3)Department of Orthopaedics & Rehabilitation, University of Iowa Hospital and Clinics, Iowa City

Purpose: Clubfoot is a birth defect that causes the feet of affected children to point inward and downward, preventing children from walking normally. In can be effectively treated with the Ponseti Method, a treatment utilizing serial casts to correct the deformity, followed by use of an abduction brace for approximately 2-4 years. The Ponseti Method of treatment requires a high degree of parental compliance with bracing protocol in order to achieve maximal effectiveness. The long duration of the process of maintaining the correction frequently poses difficulties for patients and their families. This study aimed to analyze the attitudes, perceptions, and beliefs of parents of children with congenital clubfoot regarding the Ponsetimethod of treatment; in particular, identify the aspects of treatment that families found most difficult.

Methods: Thirty families of children with congenital clubfoot were treated with the Ponseti method over a four-year period at a private clinic in São Paulo, Brazil. The treatment involved a cast phase an office-based Achilles tenotomy, followed by the use of an abduction brace until four years of age. The importance of parental involvement and correct use of the brace were strongly emphasized, and parents were provided written material explaining the treatment process and instructions for brace use. Questionnaires were distributed at the conclusion of treatment to explore the families' perspectives regarding treatment.

Results: All thirty children were successfully treated with the Ponseti method. High levels of compliance and parental involvement were achieved. All families stated that they were satisfied with the treatment outcome, and would treat a second child with clubfoot with the Ponseti method. The most difficult components of treatments included maintaining patient hygiene during the casting period, skin problems during bracing or casting, adjusting to the first week of brace use, and high levels of anxiety regarding diagnosis and anticipation of the Achilles tenotomy.

Conclusion: A strong physician-patient relationship and high levels of parental education may decrease perceived difficulties. Additionally, addressing potential difficulties before they arise may help parents better cope with the challenges of treatment; as a result, it is of utmost importance for the treating physician to be aware of what parents find to be treatment challenges.