Short-term clinical outcomes in children with idiopathic congenital talipes equinovarus who present late and managed by the modified ponseti method at Mulago Hospital

Abstract

Background: Late presentation of clubfoot remains a significant public health concern, particularly in low- and middle-income countries (LMICs), where limited access to early screening programs, inadequate health infrastructure, and sociocultural barriers often delay timely diagnosis and intervention. While the global incidence of clubfoot at birth ranges from 0.6 to 2.57 per 1000 live births, a significant proportion of these cases do not receive timely medical attention, resulting in late presentation (Ansar et al., 2018; Owen et al., 2018). Objectives: To establish the short-term clinical outcomes and associated factors in children with ICTEV who presented late and are managed by the modified Ponseti method at Mulago Hospital. Methods: This was a cross-sectional study conducted at the clubfoot clinic of Mulago Hospital, where 62 feet were studied in 40 children. Consecutive sampling was used. A questionnaire was used to obtain information on the patients’ sociodemographics and clinical treatment outcomes. Descriptive statistics were conducted to provide a general description of the study participants. Multiple logistic regression analysis was used to describe the clinical outcomes and to assess the relationship of the associated factors with the clinical outcomes. Results: The mean initial Pirani score was 5.5, reflecting severe deformity, while the mean final Pirani score dropped to 1.7, showing substantial correction. The statistical analysis demonstrates that this improvement is highly significant, with a p-value of less than 0.001. In the multivariate logistic regression analysis, several factors remained independently associated with poor short-term outcomes. Female sex was significantly associated with better outcomes compared to males, with an adjusted odds ratio of 9.87 (95% CI: 1.17–83.21), p = 0.035. Starting the bracing phase was also significantly associated with good outcomes (AOR: 0.09, 95% CI: 0.01–0.51, p = 0.007). Similarly, non-adherence to the brace significantly reduced the odds of achieving good outcomes (AOR: 0.10, 95% CI: 0.02–0.52, p = 0.006). Conclusion: In this study, 65% of participants experienced poor short-term clinical outcomes after treatment with the modified Ponseti method. Notably, the effectiveness of the method declined as the age of the patients increased. Adherence to the Ankle Foot Orthosis, initial Pirani score, and the child's sex were independent predictors of good short-term clinical outcomes in older children treated with the modified Ponseti method.