Can the Age of Initiation of Ponseti Casting Predict the Number of Casts, Duration of Treatment, and Overall Outcomes in the Management of Idiopathic Clubfoot in Infants? A Prospective Cohort Study

Background: The Ponseti method has revolutionized the management of idiopathic clubfoot, and early initiation of casting is recommended for better outcomes. Methods: This prospective study aimed to evaluate the association between the timing of clubfoot casting in infants and treatment outcomes, including the duration of therapy, number of corrective casts, and Pirani score before and after casting. A total of 76 feet in 50 patients with idiopathic clubfoot were divided into two groups based on age: group A (0–1 month) and group B (1–12 months). All patients were managed using the Ponseti method of casting. Results: The mean age of patients was 2.66 ± 2.79 months, and 55.3% of the participants were under one month of age (group A). There was a significant difference between the two groups in terms of duration of treatment (in weeks) and number of casts, with the median number of casts being highest in the age-group over 1 month. Conclusion: The findings of this study support the recommendation to initiate clubfoot casting as soon as medically reasonable, preferably within the 1st month of life, as it leads to good outcomes in terms of duration of therapy, number of corrective casts, and Pirani score before and after casting. However, starting casting beyond one month of age does not appear to adversely affect outcomes, but the number of casts and duration of therapy are less if treatment is started in the 1st month of life. Level of evidence: II.