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The Timing and Relevance of Relapsed Deformity in Patients With Idiopathic Clubfoot

Sangiorgio, Sophia Nicole PhD; Ebramzadeh, Edward PhD; Morgan, Rebecca D. BS; Zionts, Lewis E. MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: July 2017 - Volume 25 - Issue 7 - p 536–545
doi: 10.5435/JAAOS-D-16-00522
Research Article

Background: The timing and relevance of relapsed deformity after correction of idiopathic clubfoot have not been well documented.

Methods: All patients with idiopathic clubfoot seen at the authors’ institution during the study period who were followed for ≥2 years (range, 2.0 to 9.8 years) were included (N = 191). Survival analysis and multivariate regression analysis were used to analyze the data.

Results: The median age at first relapse was 20 months. The probability of relapse remained approximately 30% at age 2 years and increased to 45% by 4 years and 52% by 6 years. Parent-reported adherence with bracing reduced the odds of a relapse by 15 times (P < 0.01). After an initial relapse, adherence with bracing was successful in avoiding a subsequent relapse in 68% of patients. Feet graded as very severe on the Diméglio scale were 5.75 times more likely to relapse than those graded severe and were 7.27 times more likely than those graded as moderate.

Discussion: Patients whose parents reported nonadherence with bracing and patients with very severe deformities were most likely to relapse. After an initial relapse, regaining correction of the foot and resuming bracing were beneficial to avoid further relapses. These findings can be useful to clinicians in advising families regarding the prognosis of treatment.

Conclusions: The development of a relapse affects the subsequent management and outcome of clubfoot deformity. The importance of bracing should be reinforced to parents. Bracing until at least age 4 years may be beneficial. For patients whose families are especially resistant to brace use and for older patients who experience a second relapse, regaining correction of the deformity via cast treatment followed by an Achilles lengthening procedure and/or tendon transfer may be the best alternative.

From the J. Vernon Luck, Sr., M.D. Orthopaedic Research Center, Los Angeles, CA (Dr. Sangiorgio and Dr. Ebramzadeh), the Orthopaedic Institute for Children, Los Angeles (Ms. Morgan), and the University of California, Los Angeles (Dr. Zionts).

Correspondence to Dr. Zionts: lzionts@laoh.ucla.edu

Dr. Sangiorgio or an immediate family member has received research or institutional support from Amgen, Arthrex, and DePuy Synthes. Dr. Ebramzadeh or an immediate family member has received research or institutional support from Amgen, Arthrex, and DePuy Synthes. Neither of the following authors nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Ms. Morgan and Dr. Zionts.

Received July 07, 2016

Accepted January 02, 2017

© 2017 by American Academy of Orthopaedic Surgeons
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