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Positive Communication Paradigm Decreases Early Recurrence in Clubfoot Treatment

Morin, Matthew L. BS; Hoopes, Daniel M. MD; Szalay, Elizabeth A. MD

Journal of Pediatric Orthopaedics: March 2014 - Volume 34 - Issue 2 - p 219–222
doi: 10.1097/BPO.0000000000000080
Lower Extremity

Background: The Ponseti method has become the treatment standard for idiopathic clubfoot. Deformity recurrence is most commonly attributed to premature abandonment of the requisite abduction orthosis. A study in 2009 from our center revealed a high rate of deformity recurrence in our patient population. It was surmised that the importance of bracing to maintain correction had not been adequately communicated to some families, especially Native Americans. As a result, the principal investigator developed a different communication protocol for parents of infants.

Methods: All children treated for clubfoot at the University of New Mexico Carrie Tingley Hospital, Albuquerque, NM, from 2008 to 2010 were reviewed. They were compared with a historical control group from this institution, the subjects of the 2009 study, and were analyzed for the rate of recurrence and Pirani score improvement.

Results: Our study cohort comprised 69 infants (104 clubfeet), all of whom were treated with the new communication style. The recurrence rate for the new communication paradigm was 2.88% compared with 18.2% in the control group (P<0.001). The Pirani score improvement was 4.0 in the treatment group compared with 3.5 in the control group (P=0.001). Native American recurrence was zero in the treatment group and 41% in the control group (P=0.011).

Conclusions: A positive, rather than a negative communication style, emphasis on the brace as the most important aspect of treatment, and a more culturally sensitive family education paradigm, resulted in a lower rate of deformity recurrence when treating children with clubfeet using the Ponseti method.

Level of Evidence: Level III.

University of New Mexico School of Medicine, UNM Carrie Tingley Hospital, Albuquerque, NM

No funding from any source was received for this study.

The authors declare no conflict of interest.

Reprints: Elizabeth A. Szalay, MD, University of New Mexico School of Medicine, UNM Carrie Tingley Hospital, 1127 University Blvd. NE, Albuquerque, NM 87102. E-mail:

© 2014 by Lippincott Williams & Wilkins