Since its inception, the Ponseti method has proven to be effective in the treatment of idiopathic clubfoot in greater than 95% of cases. In those instances where the Ponseti method is unsuccessful, this failure is frequently due to noncompliance with the use of the post-casting abduction orthosis. Dobbs et al suggested that noncompliance and the educational level of parents are significant risk factors for the recurrence of clubfoot deformity, and that treating physicians should consider these factors when employing the Ponseti method. More recently, Haft et al reiterated that compliance with the post-correction abduction bracing protocol is crucial to avoid clubfoot recurrence. No study has examined an ethnically diverse North American population to assess whether distance from the site of care affects the clinical outcome of the Ponseti method. According to the 2005 United States Census Bureau, New Mexico is composed of approximately 1.8 million people, 50% of whom live in rural, medically underserved areas. The state population is composed of approximately 44% Hispanics and 10% Native Americans. Twenty-two percent of the population has less than a high school education and 22% is uninsured. The orthopaedic needs of the rural population is underserved, with many patients traveling a significant distance to receive care in Albuquerque, the only site in the state providing pediatric orthopaedic services and the only site with physicians trained in the Ponseti method. A rural family must commute weekly to Albuquerque for about 2 months for cast applications, and intermittently thereafter for follow up and orthotic management. This travel may be difficult or impossible for families living a far distance from the treatment site. While prior studies have demonstrated effective Ponseti treatment in certain rural populations, no distinction has been made between patients living close and those living a significant distance from the site of treatment. Since compliance with the abduction orthosis is essential to maintain correction, orthotic follow-up, fitting, and compliance is at increasing risk the more difficult the travel to the site of care. New Mexico, with its large rural areas and economic and ethnic diversity, offers an opportunity to examine how these factors affect both initial deformity correction and maintenance of correction using the abduction orthosis. Our hypothesis was that the success of the Ponseti treatment was related to economic factors coupled with distance to the care center.
Avilucea, Frank; Elizabeth Szalay; Richard Schwend; Patrick Bosch; and Katherine Sweet. "Do Cultural Factors Affect Outcome in Ponseti Treatment for Clubfeet in Rural America?." (2009). http://digitalrepository.unm.edu/ume-research-papers/63