Effects of younger siblings on the brace compliance and recurrence in children with clubfoot during Ponseti treatment

Objective: This study aimed to determine the effects of the number of total siblings, younger siblings, and complex clubfoot deformity onthe brace compliance and recurrence in the management of children with clubfoot deformity using the Ponseti technique.Methods: The data from 91 children, including 22 girls and 69 boys (total 130 idiopathic clubfeet), seen from 2016 to 2019 were prospectivelycollected and retrospectively reviewed. The deformity was unilateral in 52 (57.1%) children (32 right, 20 left) and bilateral in 39 (42.9%). Themean age at presentation was 2 (range, 1–30) weeks, and the mean follow-up was 21.5 (range, 12–36) months. All the clubfeet were treated according to the Ponseti method. After removing the cast, a foot abduction brace (Dennis Brown splint) was worn. A complex clubfoot deformitywas identified in 12% (n=11) children. At the follow-up, the Pirani score, recurrence status, and brace compliance were recorded. Recurrentdeformity was defined as any deformity recurrence requiring manipulation, recasting, or surgical treatment. Brace compliance was assessedper the parents’ report.Results: The median number of children in a family was 3 (range, 1–12). A total of 53 (58.2%) parents had up to 3 children, and 38 (41.8%)parents had more than 3 children. Of the patients, 22 (24.2%) had younger siblings and 25 (26.4%) had a family history of clubfoot. A totalof 58 feet (44.6%) in 40 children (43.9%) developed recurrence. Brace non-compliance was the main risk factor for recurrence, increasingthe recurrence rate 32-fold compared with that of compliant parents (odds ratio [OR], 32.67, 95% confidence interval [CI], 10.02–106.49;p=0.001). The rate of non-compliance with brace use was 51.6% (n=47). Brace non-compliance was significantly associated with having ayounger sibling (OR, 3.9; 95% CI, 1.36–11.2; p=0.011) and having a complex deformity (OR, 11.62; 95% CI, 1.42–95.1; p=0.022) but was notassociated with the total number of children (OR, 1.61; 95% CI, 0.7–3.73; p=0.265).Conclusion: Our study shows that having new siblings in the first years of the Ponseti treatment may increase the brace non-complianceby minimizing the attention paid to the children with clubfeet by their parents. Nonetheless, complex clubfoot deformity may promotebrace compliance by increasing the parents’ interest during the treatment process.Level of Evidence: Level IV, Therapeutic Study

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