Difficulties in maintenance of clubfoot abduction brace and solutions - maintenance of clubfoot abduction brace, locks and keys.

Objective: To determine the frequency of early relapse after achieving good initial correction in children who were on clubfoot abduction brace.

Methods: The cross-sectional study was conducted at the Jinnah Postgraduate Medical Centre, Karachi, and included parents of children of either gender in the age range of 6 months to 3years with idiopathic clubfoot deformities who had undergone Ponseti treatment between September 2012 and June 2013, and who were on maintenance brace when the data was collected from December 2013 to March 2014. Parents of patients with follow-up duration in brace less than six months and those with syndromic clubfoot deformity were excluded. The interviews were taken through a purposive designed questionnaire. SPSS 16 was used for data analysis.

Results: The study included parents of 120 patients. Of them, 95(79.2%) behaved with good compliance on Denis Browne Splint, 10(8.3%) were fair and 15(12.5%)showed poor compliance. Major reason for poor and non-compliance was unaffordability of time and cost for regular follow-up. Besides, 20(16.67%) had inconsistent use due to delay inre-procurement of Foot Abduction Braceonce the child had outgrown the shoe. Only 4(3.33%) talked of cultural barriers and conflict of interest between the parents. Early relapse was observed in 23(19.16%) patients and 6(5%) of them responded to additional treatment and were put back on brace treatment; 13(10.83%) had minor relapse with forefoot varus, without functional disability, and the remaining 4(3.33%) had major relapse requiring extensive surgery. Overall success was recorded in 116(96.67%) cases.

Conclusions: The positioning of shoes on abduction brace bar, comfort in shoes, affordability, initial and subsequent delay in procurement of new shoes once the child's feet overgrew the shoe, were the four containable factors on the part of Ponseti practitioner.