A Retrospective Review Assessing the Impact of Socioeconomic Factors on Brace Adherence in Clubfoot Patients Treated with the Ponseti Method

Objective: The Ponseti method is a widely adopted nonsurgical approach for correcting clubfoot deformities, but its success relies heavily on consistent brace usage during the maintenance phase. The present study seeks to analyze whether socioeconomic factors affect brace adherence in clubfoot patients. Study Design: The present study was reviewed and approved by the Institutional Review Board. The charts of 83 patients treated for clubfoot by two providers at a single institution between 2013 and 2022 were reviewed to investigate the impact of various socioeconomic variables on brace adherence and its association with treatment outcomes. Brace adherence was determined based on provider documentation noting self-reported parental accounts of adherence. Annual family income was derived from North Carolina census data based on zip code. Chi-squared tests and two sample t-tests analyses were performed, controlling for clinical factors such as treatment strategy, comorbidities, laterality, and prenatal diagnosis. Results: Patients from families with higher annual income based on zip codes demonstrated higher brace adherence rates. Patients from racial minority backgrounds exhibited reduced adherence with brace usage, likely in the context of greater obstacles to care. No significant correlations were found between brace adherence and distance to the hospital, gender, or language. Conclusion: The findings highlight the multifaceted nature of brace adherence in clubfoot patients undergoing Ponseti treatment, suggesting the importance of addressing specific patient demographics, socioeconomic contexts, and caregiver support structures to optimize treatment outcomes. Further research involving a larger and more diverse cohort is necessary to validate these findings. Keywords: Clubfoot, Social determinants of health, Clinical outcomes, Brace compliance.