Factors predicting brace noncompliance among idiopathic clubfoot patients treated with the Ponseti method

Objectives: The purpose of this study was to determine the compliance of parents of children with clubfeet treated with the Ponseti method and to identify factors that may predict brace non-compliance. Methods: A myriad of factors affecting families' compliance were assessed by administering questionnaires to 108 patients with clubfoot from December 2009 to January 2012. The family's demographic data, including monthly income, educational level of the parents, number of children in the family, and other factors, were studied and statistically analysed. Results: All 108 patients had severe clubfoot. The parents of 72 (66.7%) patients complied with the use of the brace compared to 36 (33.3%) parents who did not comply. Unilateral clubfoot was a significant risk factor for non-compliant parents compared to bilateral clubfeet (p = 0.05). Parents with 3 or more children had more non-compliance (66.7%) compared to those with less than 3 children (38.9%). All non-compliant parents reported that their babies cried during the application of the brace in contrast to 25% of the complaint parents (p < 0.0001). The majority of non-compliant parents (94.4%) reported being "fed up" with using the brace compared to 2.8% of the compliant parents. No significant correlation was found between brace use and parents' monthly income or their level of education. Conclusion: More children per family, unilateral clubfoot, and the inability of a single parent alone to apply the brace were found to be major risk factors for brace non-compliance. Families' awareness about the importance of the brace and encouragement might improve brace compliance.