Factors responsible for dropout in the Ponseti method of clubfoot treatment: A cross-sectional study.

BACKGROUND

The Ponseti method for clubfoot treatment is a non-surgical treatment with a successful outcome. However, many children are not able to complete Ponseti treatment due to various barriers and are termed dropout children. This study aimed to find out the factors responsible for dropout from clubfoot treatment in Peshawar, Pakistan.

METHODS

The study was conducted in the Clubfoot Department of a tertiary care hospital. Clinical and demographic information like age, casting phase, bracing phase, and clubfoot types, i.e., idiopathic, syndromic, or neurogenic, were extracted from the hospital database, while for dropout factors, a semi-structured questionnaire was used. Descriptive statistics were applied to demographic data, assessments, and semi-structured questionnaires for parents. The association of dropout rates with age, gender, and unilaterally/bilaterally clubfoot was analyzed through chi-square tests.

RESULTS

Between December 2017 and December 2022, a total of 1,150 babies were treated with the Ponseti method in the Clubfoot Department. Of 1,150 patients, 197 (17.1%) patients dropped out of the treatment. Twenty-four (12.1%) patients of this dropout were from the casting phase, and 173 (87.9%) patients were from the bracing phase. Age was found to be a significant factor affecting dropout from the Ponseti method. No significant association was found between the patient's dropout and gender or between dropout and unilaterally/bilaterally clubfoot.

CONCLUSION

The Ponseti method improves clubfoot treatment but faces high dropout rates due to barriers like lack of family support and transport issues. Clinics addressed this by offering family support, transportation aid, telemedicine, community outreach, financial aid, peer support, and extended hours, reducing dropout rates and enhancing outcomes.