Bracing for Impact: A Survey Analysis of the Impact of Socioeconomic Factors on Brace Adherence in Clubfoot

Background: Clubfoot is a congenital deformity characterized by cavus deformity of the midfoot, adductus of the forefoot and equinus and varus of the hindfoot. The Ponseti method, a series of casting and bracing protocols has become the standard of care as a highly effective non-surgical intervention. Poor adherence with stringent brace wearing protocols has been identified as one of the leading causes of deformity recurrence with the Ponseti method. The present study seeks to uncover the socioeconomic variables which may contribute to brace adherence. Methods: This survey study included 219 patients, 56 responded (25.5% RR). The survey assessed zip code, annual income, number of caregivers and siblings, brace adherence, and recurrence. Adherence was measured categorically (Likert) and continuously (0-100%); recurrence was measured categorically (yes/no). A t-test was used to evaluate the relationship between adherence and deformity recurrence. All other variables were analyzed using chi squared and Fischer’s exact. Results: 23 patients reported an annual income of $100,000 or greater (n=23), and most had received at least a college education (n=37), many had graduate’s degrees (n=20), most reported two caregivers (n=44), and 1 sibling (n=21). 36 patients reported brace wearing All of the time, and 21 patients reported their child needing to repeat serial casting or additional surgery, indicating recurrence. No significant relationship was found between brace adherence and deformity recurrence (p>0.05). No significant relationship was found between annual income, number of caregivers, highest level of education, number of siblings against brace adherence (p>0.05). Conclusion: These findings contrast with the well-documented risk of recurrence with decreased brace adherence; perhaps due to parental overreporting of brace wearing. The expected relationship between social variables and brace adherence was also not supported potentially because of a skew in our population towards patients with higher education and income. Keywords: Clubfoot, Social Determinants of Health, Clinical Outcomes, Brace Compliance