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High Recurrence in Native American Infants with Clubfoot

Rural families show low compliance with Ponseti bracing treatment

WEDNESDAY, Mar. 4 (HealthDay News) -- Native American infants with clubfoot living in rural areas and treated by the non-surgical Ponseti method are at high risk of recurrence due to low compliance with the bracing protocol, according to a report in the March issue of the Journal of Bone & Joint Surgery.

Frank R. Avilucea, and colleagues from the University of New Mexico Carrie Tingley Hospital in Albuquerque, N.M., compared early recurrence after Ponseti treatment (subsequent cast treatment or surgical treatment) in 100 ethnically diverse infants with a total of 138 clubfeet living in urban and rural areas to determine whether distance from the site of care affected compliance (strict adherence to the brace protocol).

The researchers found that 34 infants had early recurrence, including 18 from a rural area. Of these 18 infants, 14 were Native American, and all had not adhered to the brace protocol as outlined by the physician, the authors note. The risk of recurrence was significantly higher in infants who discontinued the use of orthotics prematurely (odds ratio, 120). Other factors increasing the risk of recurrence in patients living in a rural area were Native American ethnicity, unmarried parents, public or no insurance, low parental education (high school or less) and low family income (less than $20,000 annually), the report indicates.

"Compliance with the orthotic regimen after cast treatment is imperative for the Ponseti method to succeed," Avilucea and colleagues conclude. "The striking difference in outcome in rural Native American patients as compared with the outcomes in urban Native American patients and children of other ethnicities suggests particular problems in communicating to families in this subpopulation the importance of bracing to maintain correction."

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