O2108: Understanding Clubfoot Recurrence: Insights from a Social Determinants Perspective

Background: Clubfoot recurrence after the Ponseti method occurs in up to 40% of patients. Studied risk factors for recurrence include adherence to abduction braces, severity of initial deformity, and age of treatment initiation. Although it is widely recognized that social determinants of health can influence patient outcomes, the available research on clubfoot recurrence has not thoroughly investigated their effects. Barriers to timely diagnosis, access to specialized clinics, and adherence to post-treatment care may all play a role in recurrence. It is important to understand how parental education, financial constraints, and work-related commitments may impact a family's ability to follow through with the recommended treatment plan for a child. The current study investigates the social determinants of health contributing to clubfoot recurrence.

Methods: This is a retrospective study of children treated for clubfoot between 2018 and 2022. The inclusion criteria were the diagnosis of idiopathic clubfoot, treated by the Ponseti method, and followed up for at least twelve months. A comprehensive medical record search collected recurrence status, adherence to abduction braces, and demographic information. Recurrence was defined as repeat casting, with or without a procedure, despite prescribed brace use. Additionally, a Social Deprivation Index (SDI) was assigned to each patient's zip code. The SDI is a composite score (0-100) of area-level deprivation based on seven demographic characteristics obtained from the American Community Survey, with a positive relationship between the SDI score and the severity of deprivation.

Results: We identified 74 patients who met our inclusion criteria. Forty-three patients (58%) had an SDI>75. Twenty-five patients (34%) experienced a recurrence. Of these, thirteen (52%) had an SDI>75. The proportion of patients who experienced a recurrence with an SDI>75 did not differ from that of the general population of patients (p=0.596). Among the 16 patients who were not adherent to the bracing protocol, 9 (56%) had an SDI>75.

Conclusion: In our cohort, patients from disadvantaged populations did not have an increased rate of non-adherence to the bracing protocol, nor was there an increased proportion of patients who developed a recurrence.
These results confirm data from a recent study that local factors, such as accessibility of care and close follow up of patients, may decrease the impact of social deprivation on patient outcomes. Further research is needed in local clubfoot clinics to assess the impact, or lack thereof, of social determinants on health outcomes in patients treated by the Ponseti Method for clubfoot.